MS3 Exam 3 Practice Questions

You are treating a 52 year old man who was involved in a serious high-speed collision. If the patient is up and walking around at the scene, you should: a. assess for a potential spinal injury b. check with medical direction for orders c. check with bystanders about the patient's mental status d. assume that the patient is uninjured

A

What is the normal Urine Glucose lab value?

0

What is the normal lab value for Urine Nitrates?

0

What is the normal lab value for Serum Creatinine?

0.6-1.2 mg/dL

You are treating an approximately 20 year old male trauma patient who was found unconscious at the bottom of a stairway. The unconscious trauma patient should be: a. treated as if he has a spine injury b. rolled immediately to check for back injuries c. placed in the recovery position d. placed in a prone position for fluid to drain

A

You suspect that your patient may have a traumatic brain injury. His signs and symptoms may include: a. blood or fluid flowing from the ears and/or nose b. yellow discoloration in the eyes c. bruising around the base of the nose d. pain at the base of the neck

A

The client is admitted with full-thickness burns may be developing DIC. Which signs/symptoms would support the diagnosis of DIC? 1. Oozing blood from the IV catheter site 2. Sudden onset of chest pain and frothy sputum 3. Foul smelling, concentrated urine 4. A reddened, inflamed central line catheter site

1. Signs and symptoms of DIC result from clotting and bleeding, ranging from oozing blood to bleeding from every body orifice and into the tissues

What is the normal lab value for Urine Specific Gravity?

1.01-1.03

Emergency medical technicians arrive at the emergency department with an unresponsive client who has an oxygen mask in place. Which action should the nurse take first? a. Assess that the client is breathing adequately. b. Insert a large-bore intravenous line. c. Place the client on a cardiac monitor. d. Assess for the best neurologic response.

A ~ The highest-priority intervention in the primary survey is to establish that the client is breathing adequately. Even though this client has an oxygen mask on, he or she may not be breathing, or may be breathing inadequately with the device in place.

Which lab result would the nurse expect in the client diagnosed with DIC? 1. A decreased prothrombin time (PT) 2. A low fibrinogen level 3. An increased platelet count 4. An increased white blood cell count

2. Fibrinogen level helps predict bleeding in DIC. As it becomes lower, the risk of bleeding increases.

When a child has chronic renal failure, the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as: a. uremia. b. oliguria. c. proteinuria. d. pyelonephritis.

A ~ Uremia is the retention of nitrogenous products, producing toxic symptoms. Oliguria is diminished urinary output. Proteinuria is the presence of protein, usually albumin, in the urine. Pyelonephritis is an inflammation of the kidney and renal pelvis.

After performing the primary assessment and rapid trauma exam on a spine injured patient, your next step is to: a. determine the patient's priority b. administer high-concentration oxygen c. immobilize the patient on a long spine board d. determine the mechanism of injury

A

If a responsive patient has the mechanism of injury of a spinal injury, the EMT should do all of the following except: a. assess for spinal pain by asking the patient to move b. keep the patient still while asking him or her questions c. assess for equality of strength in the extremities d. assess for tingling in the extremities

A

When assessing a suspected spine injured patient, you note a reversal of the normal breathing pattern. This is likely a result of damage to the nerves that control the: a. rib cage b. diaphragm c. abdomen d. lungs

A

When immobilizing a 6 year old or younger child on a long backboard: a. provide padding beneath the shoulder blades b. it is unnecessary to apply a cervical collar c. place a chin cup or chin strap on the patient d. secure the head first and then secure the torso

A

Which of the following is a late sign of skull or traumatic brain injury? a. temperature increase b. raccoon eyes c. irregular breathing patterns d. battle's sign

A

You are treating a 35 year old female who failed to wear a helmet and struck her head when she fell off her bike. In most EMS systems, she would be taken to a trauma center if her Glasgow Coma Scale (GCS) score was less than: a. 8 b. 10 c. 12 d. 15

A

An emergency department (ED) nurse is preparing to transfer a client to the trauma intensive care unit. Which information should the nurse include in the nurse-to-nurse hand-off report? (SATA) a. Mechanism of injury b. Diagnostic test results c. Immunizations d. List of home medications e. Isolation precautions

A, B, E ~ Hand-off communication should be comprehensive so that the receiving nurse can continue care for the client fluidly. Communication should be concise and should include only the most essential information for a safe transition in care. Hand-off communication should include the clients situation (reason for being in the ED), brief medical history, assessment and diagnostic findings, Transmission-Based Precautions needed, interventions provided, and response to those interventions.

The nurse monitoring a client load for risks of acute renal failure (ARF) understands that older clients are more susceptible to ARF because (SATA) a. cardiac contractile function and kidney perfusion diminish with age. b. medication use is generally lower in this age group. c. of a higher probability of pre-existing renal damage. d. older adults have more difficulty with fluid balance in general. e. the ability to retain sodium declines with age.

A, C, D, E ~ There are several reasons why older clients are at increased risk of ARF, including options a, c, d, and e. Older clients also have more difficulty concentrating urine. Elderly clients in general take more medications that do clients in other age groups.

The complex care provided during an emergency requires interdisciplinary collaboration. Which interdisciplinary team members are paired with the correct responsibilities? (SATA) a. Psychiatric crisis nurse Interacts with clients and families when sudden illness, serious injury, or death of a loved one may cause a crisis b. Forensic nurse examiner Performs rapid assessments to ensure clients with the highest acuity receive the quickest evaluation, treatment, and prioritization of resources c. Triage nurse Provides basic life support interventions such as oxygen, basic wound care, splinting, spinal immobilization, and monitoring of vital signs d. Emergency medical technician Obtains client histories, collects evidence, and offers counseling and follow-up care for victims of rape, child abuse, and domestic violence e. Paramedic Provides prehospital advanced life support, including cardiac monitoring, advanced airway man

A, E ~ The psychiatric crisis nurse evaluates clients with emotional behaviors or mental illness and facilitates follow-up treatment plans. The psychiatric crisis nurse also works with clients and families when experiencing a crisis. Paramedics are advanced life support providers who can perform advanced techniques that may include cardiac monitoring, advanced airway management and intubation, establishing IV access, and administering drugs en route to the emergency department. The forensic nurse examiner is trained to recognize evidence of abuse and to intervene on the clients behalf. The forensic nurse examiner will obtain client histories, collect evidence, and offer counseling and follow-up care for victims of rape, child abuse, and domestic violence. The triage nurse performs rapid assessments to ensure clients with the highest acuity receive the quickest evaluation, treatment, and prioritization of resources. The emergency medical technician is usually the first caregiver and provides basic life support and transportation to the emergency department.

What type of motor vehicle crash poses the LEAST threat for abdominal trauma if the patient is properly restrained? A. Rear-end crash B. Frontal crash C. Lateral crash D. Rollover crash

A. Rear-end crash

Which of the following statements regarding stomach injuries is correct? A. Rupture of the stomach following blunt trauma is usually associated with a recent meal or inappropriate seat belt use. B. The vast majority of injuries to the stomach are caused by blunt force trauma and result in severe peritoneal hemorrhage C. Penetrating mechanisms are a rare cause of injury to the stomach because the stomach is well protected by the abdominal musculature D. Patients taking antacid medications usually experience immediate signs of peritoneal irritation following an injury to the stomach

A. Rupture of the stomach following blunt trauma is usually associated with a recent meal or inappropriate seat belt use.

Intraabdominal bleeding may produce few signs and symptoms of trauma because: A. The intraabdominal cavity can accommodate large amounts of blood B. The abdominal musculature can sustain massive blunt force without bruising C. It takes approximately 4 L of blood loss before signs of shock manifest D. Blood in the peritoneum can compress the aorta and maintain perfusion

A. The intraabdominal cavity can accommodate large amounts of blood

Skull or traumatic brain injury may result in: a. airway swelling and dizziness b. altered mental status and unequal pupils c. difficulty moving below the waist d. headache and hypoperfusion

B

The function of the spinal column is to: a. produce cerebrospinal fluid b. protect the spinal cord c. allow for back movement in all directions d. manufacture platelets

B

The patient does not complain of any spinal pain. It is important to remember that a lack of spinal pain does not rule out the possibility of spinal cord injury because: a. spinal injuries seldom cause pain b. other painful injuries may mask it c. spinal injuries are not painful until shock sets in d. a patient may feel the pain but cannot verbalize it

B

What is the significance of an increase in carbon dioxide in the injured brain? a. it decreases the blood pressure b. it causes brain tissue swelling c. it raises the heart rate d. it causes brain tissue shrinkage

B

You are assessing a 22 year old male who was involved in a bar fight earlier this evening. It is now 4am and the family called the ambulance because he has been vomiting. You notice he has a bruise behind the ear. Further assessment reveals that he also has discoloration of the soft tissues under both eyes. This finding is called: a. Cushing's disease b. Raccoon eyes c. Battle's sign d. Posturing syndrome

B

You are assessing a 27 year old male who you suspect has a spine injury. If he complains of pain when you attempt to place his head in a neutral in-line position, you should: a. pad the neck before immobilizing b. steady the head in the position found c. continue with the stabilization procedure d. contact medical direction immediately

B

You are assessing a 27 year old male who you suspect has a spine injury. One EMT on your crew should: a. strap the patient's head, then the torso, to the long spine board b. maintain constant manual in-line immobilization until the patient is secured to a backboard c. assess for range of cervical spine motion d. pad the neck before stabilizing

B

You are treating a 19 year old male who was in a fight. His face has multiple fractures, his nose is broken, and his jaw may be fractured. The primary concern for emergency care of a facial fracture or jaw injury is the: a. external bleeding b. patient's airway c. loss of teeth d. basilar skull fracture

B

You are treating a 45 year old male who was involved in a high speed car crash. You have decided to use the rapid extrication technique, which is typically used in all of the following situations except when: a. moving a patient rapidly from a unsafe scene b. a stable, low priority patient must be immobilized c. more seriously injured patients must be accessed d. moving a high priority patient

B

Your patient is a 19 year old male who was involved in a motorcycle crash. You should consider keeping the helmet on the patient: a. if it interferes with breathing management b. if it has a snug fit that allows no head movement c. by using a two-rescuer procedure d. if it hinders immobilization

B

A nurse is triaging clients in the emergency department (ED). Which client should the nurse prioritize to receive care first? a. A 22-year-old with a painful and swollen right wrist b. A 45-year-old reporting chest pain and diaphoresis c. A 60-year-old reporting difficulty swallowing and nausea d. An 81-year-old with a respiratory rate of 28 breaths/min and a temperature of 101 F

B ~ A client experiencing chest pain and diaphoresis would be classified as emergent and would be triaged immediately to a treatment room in the ED. The other clients are more stable.

A nurse is planning care for a client who has chronic kidney disease. Which of the following interventions would help the client meet a priority outcome? a. Delegate monitoring vital signs during dialysis to the nurse's aide. b. Instruct the client not to get out of bed without assistance. c. Place a sign on the door outlining the fluid allotment for each shift. d. Plan to weigh the client each morning on the same scale.

B ~ Almost 90% of clients with chronic kidney disease have renal osteodystrophy. This demineralization of the bones leaves them vulnerable to fracture with slight trauma. The client should have assistance when getting out of bed to avoid injury. Client safety is a TJC priority. Option a does not meet a client outcome; option c is a good idea, except then the client cannot see how fluids are divided over the day; option d is a good intervention to monitor fluid status, but does not address a safety need.

To assess the effect of epoetin alfa on a client with chronic renal failure, the nurse would monitor a. blood urea nitrogen level. b. hematocrit level. c. leukocyte count. d. serum creatinine level.

B ~ Anemia in clients with chronic renal failure is treated primarily with erythropoietin, a hormone produced in the kidney that stimulates red blood cell production.

The emergency department team is performing cardiopulmonary resuscitation on a client when the client's spouse arrives at the emergency department. Which action should the nurse take first? a. Request that the client's spouse sit in the waiting room. b. Ask the spouse if he wishes to be present during the resuscitation. c. Suggest that the spouse begin to pray for the client. d. Refer the client's spouse to the hospitals crisis team.

B ~ If resuscitation efforts are still under way when the family arrives, one or two family members may be given the opportunity to be present during lifesaving procedures. The other options do not give the spouse the opportunity to be present for the client or to begin to have closure.

A nurse is evaluating levels and functions of trauma centers. Which function is appropriately paired with the level of the trauma center? a. Level I Located within remote areas and provides advanced life support within resource capabilities b. Level II Located within community hospitals and provides care to most injured clients c. Level III Located in rural communities and provides only basic care to clients d. Level IV Located in large teaching hospitals and provides a full continuum of trauma care for all clients

B ~ Level I trauma centers are usually located in large teaching hospital systems and provide a full continuum of trauma care for all clients. Both Level II and Level III facilities are usually located in community hospitals. These trauma centers provide care for most clients and transport to Level I centers when client needs exceed resource capabilities. Level IV trauma centers are usually located in rural and remote areas. These centers provide basic care, stabilization, and advanced life support while transfer arrangements to higher-level trauma centers are made.

A trauma client with multiple open wounds is brought to the emergency department in cardiac arrest. Which action should the nurse take prior to providing advanced cardiac life support? a. Contact the on-call orthopedic surgeon. b. Don personal protective equipment. c. Notify the Rapid Response Team. d. Obtain a complete history from the paramedic.

B ~ Nurses must recognize and plan for a high risk of contamination with blood and body fluids when engaging in trauma resuscitation. Standard Precautions should be taken in all resuscitation situations and at other times when exposure to blood and body fluids is likely. Proper attire consists of an impervious cover gown, gloves, eye protection, a facemask, a surgical cap, and shoe covers.

A nurse is caring for clients in a busy emergency department. Which actions should the nurse take to ensure client and staff safety? (SATA) a. Leave the stretcher in the lowest position with rails down so that the client can access the bathroom. b. Use two identifiers before each intervention and before mediation administration. c. Attempt de-escalation strategies for clients who demonstrate aggressive behaviors. d. Search the belongings of clients with altered mental status to gain essential medical information. e. Isolate clients who have immune suppression disorders to prevent hospital-acquired infections.

B, C, D ~ To ensure client and staff safety, nurses should use two identifiers per The Joint Commissions National Patient Safety Goals; follow the hospitals security plan, including de-escalation strategies for people who demonstrate aggressive or violent tendencies; and search belongings to identify essential medical information. Nurses should also use standard fall prevention interventions, including leaving stretchers in the lowest position with rails up, and isolating clients who present with signs and symptoms of contagious infectious disorders.

An emergency room nurse is caring for a trauma client. Which interventions should the nurse perform during the primary survey? (SATA) a. Foley catheterization b. Needle decompression c. Initiating IV fluids d. Splinting open fractures e. Endotracheal intubation f. Removing wet clothing g. Laceration repair

B, C, E, F ~ The primary survey for a trauma client organizes the approach to the client so that life-threatening injuries are rapidly identified and managed. The primary survey is based on the standard mnemonic ABC, with an added D and E: Airway and cervical spine control; Breathing; Circulation; Disability; and Exposure. After the completion of primary diagnostic and laboratory studies, and the insertion of gastric and urinary tubes, the secondary survey (a complete head-to-toe assessment) can be carried out.

The LEAST practical technique when assessing the patient with abdominal trauma in the field is: A. Palpation B. Auscultation C. Inspection D. Percussion

B. Auscultation

A 59 year old construction worker collapsed on the job and fell into a pile of steel rods. Your assessment reveals that he is pulseless and apneic, and has a 12 inch steel rod impaled in his epigastrium. As your partner and an emergency medical responder begin CPR, you should: A. Trim the steel rod to 6inches, stabilize it in place with bulky dressing, apply firm direct pressure around the rod, and initiate IV therapy en route to a trauma center B. Control any external bleeding, stabilize the rod in place with bulky dressings, apply the cardiac monitor, and start at least one large-bore IV line en route to the hospital C. Remove the rod so you can perform effective CPR, control any external bleeding, start two large bore IV lines, and assess his cardiac rhythm en route to the hospital D. Carefully remove the steel rod, apply direct pressure to the wound, assess his cardiac rhythm, start a large bore IV line and g

B. Control any external bleeding, stabilize the rod in place with bulky dressings, apply the cardiac monitor, and start at least one large-bore IV line en route to the hospital

What organs are the primary sources of exsanguination during abdominal trauma? A. Kidneys and liver B. Liver and spleen C. Spleen and kidneys D. Stomach and liver

B. Liver and spleen

What membranous tissue functions as the point of attachment for the various abdominal organs? A. Pleura B. Mesentery C. Peritoneum D. Ligamentum arteriosum

B. Mesentery

If a stable 22 year old male patient is found in a sitting position on the ground and is complaining about back pain, the EMT should: a. apply a cervical collar and rapidly transport the patient b. ask the patient to lie down, then immobilize c. immobilize with a short splint board or extrication vest d. perform a rapid take-down procedure with a long spine board

C

On your size-up of an automobile collision, you notice that both sides of the windshield have a spider-web crack. It is wise to call for a backup ambulance because: a. every collision should have a two ambulance response b. patients hitting their heads on the windshield will be critical c. both the driver and the passenger require spinal injury treatment d. it takes four EMS personnel to properly immobilize one patient.

C

The spine is made up of ____ vertebrae. a. 35 b. 23 c. 33 d. 38

C

When a patient has a scalp injury: a. expect minimal bleeding b. determine the wound depth c. expect profuse bleeding d. palpate the site with the fingertips

C

When the spine is excessively pulled, which commonly occurs during a hanging, this is called a(n) ___ injury. a. excessive rotation b. lateral bending c. distraction d. compression

C

Which of the following is generally not a sign of traumatic brain injury, except in infants? a. bleeding from the nose and ears b. unequal pupils c. hypoperfusion d. seizures

C

Which of the following statements about the rigid cervical collar is false? a. a collar of an incorrect size can hyperextend the neck b. maintain manual stabilization when applying a rigid cervical collar c. the collar completely eliminates neck movement d. the collar should never obstruct the airway

C

You are assessing a 22 year old male who was involved in a bar fight earlier this evening. It is now 4am and the family called the ambulance because he has been vomiting. You notice he has a bruise behind the ear. This is called: a. Cushing's disease b. Raccoon eyes c. Battle's sign d. Posturing syndrome

C

You are treating a 22 year old male who was assaulted with a knife. The attacker slashed the patient's throat. Initially there was considerable blood, but you were able to control it and bandage the wound. The patient went into sudden cardiac arrest. What is the most likely cause? a. a stroke b. a heart attack c. an air embolism d. infection from the wound

C

Your patient fell down the stairs and may have injured his spine. Examples of findings that may lead you to consider a spine injury include all of the following except: a. the presence of priapism b. the loss of bladder control c. an increased pulse rate d. nerve impairment to the extremities

C

A nurse is triaging clients in the emergency department. Which client should the nurse classify as nonurgent? a. A 44-year-old with chest pain and diaphoresis b. A 50-year-old with chest trauma and absent breath sounds c. A 62-year-old with a simple fracture of the left arm d. A 79-year-old with a temperature of 104 F

C ~ A client in a nonurgent category can tolerate waiting several hours for health care services without a significant risk of clinical deterioration. The client with a simple arm fracture and palpable radial pulses is currently stable, is not at significant risk of clinical deterioration, and would be considered nonurgent. The client with chest pain and diaphoresis and the client with chest trauma are emergent owing to the potential for clinical deterioration and would be seen immediately. The client with a high fever may be stable now but also has a risk of deterioration.

A nurse is triaging clients in the emergency department. Which client should be considered urgent? a. A 20-year-old female with a chest stab wound and tachycardia b. A 45-year-old homeless man with a skin rash and sore throat c. A 75-year-old female with a cough and a temperature of 102 F d. A 50-year-old male with new-onset confusion and slurred speech

C ~ A client with a cough and a temperature of 102 F is urgent. This client is at risk for deterioration and needs to be seen quickly, but is not in an immediately life-threatening situation. The client with a chest stab wound and tachycardia and the client with new-onset confusion and slurred speech should be triaged as emergent. The client with a skin rash and a sore throat is not at risk for deterioration and would be triaged as nonurgent.

While triaging clients in a crowded emergency department, a nurse assesses a client who presents with symptoms of tuberculosis. Which action should the nurse take first? a. Apply oxygen via nasal cannula. b. Administer intravenous 0.9% saline solution. c. Transfer the client to a negative-pressure room. d. Obtain a sputum culture and sensitivity.

C ~ A client with signs and symptoms of tuberculosis or other airborne pathogens should be placed in a negative-pressure room to prevent contamination of staff, clients & family members in the crowded emergency department.

An emergency room nurse assesses a client who has been raped. With which health care team member should the nurse collaborate when planning this client's care? a. Emergency medicine physician b. Case manager c. Forensic nurse examiner d. Psychiatric crisis nurse

C ~ All other members of the health care team listed may be used in the management of this client's care. However, the forensic nurse examiner is educated to obtain client histories and collect evidence dealing with the assault, and can offer the counseling and follow-up needed when dealing with the victim of an assault.

An emergency department (ED) case manager is consulted for a client who is homeless. Which intervention should the case manager provide? a. Communicate client needs and restrictions to support staff. b. Prescribe low-cost antibiotics to treat community-acquired infection. c. Provide referrals to subsidized community-based health clinics. d. Offer counseling for substance abuse and mental health disorders.

C ~ Case management interventions include facilitating referrals to primary care providers who are accepting new clients or to subsidized community-based health clinics for clients or families in need of routine services. The ED nurse is accountable for communicating pertinent staff considerations, client needs, and restrictions to support staff (e.g., physical limitations, isolation precautions) to ensure that ongoing client and staff safety issues are addressed. The ED physician prescribes medications and treatments. The psychiatric nurse team evaluates clients with emotional behaviors or mental illness and facilitates the follow-up treatment plan, including possible admission to an appropriate psychiatric facility.

Which is a major complication in a child with chronic renal failure? a. Hypokalemia b. Metabolic alkalosis c. Water and sodium retention d. Excessive excretion of blood urea nitrogen

C ~ Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of blood urea nitrogen are complications of chronic renal failure.

During peritoneal dialysis the client's dialysate white blood cell count is 150/mm3 and neutrophils are 60%. This would indicate that the client has developed a. anemia. b. bowel perforation. c. peritonitis. d. pyelonephritis.

C ~ Peritonitis is diagnosed when the dialysate white blood cell count is greater than 100/mm3 and neutrophils are greater than 50%.

An emergency room nurse is triaging victims of a multi-casualty event. Which client should receive care first? a. A 30-year-old distraught mother holding her crying child b. A 65-year-old conscious male with a head laceration c. A 26-year-old male who has pale, cool, clammy skin d. A 48-year-old with a simple fracture of the lower leg

C ~ The client with pale, cool, clammy skin is in shock and needs immediate medical attention. The mother does not have injuries and so would be the lowest priority. The other two people need medical attention soon, but not at the expense of a person in shock.

An emergency department nurse is caring for a client who is homeless. Which action should the nurse take to gain the clients trust? a. Speak in a quiet and monotone voice. b. Avoid eye contact with the client. c. Listen to the client's concerns and needs. d. Ask security to store the client's belongings.

C ~ To demonstrate behaviors that promote trust with homeless clients, the emergency room nurse should make eye contact (if culturally appropriate), speak calmly, avoid any prejudicial or stereotypical remarks, show genuine care and concern by listening, and follow through on promises. The nurse should also respect the client's belongings and personal space.

Fractures of the lower rib cage should make you MOST suspicious for injuries to the: A. Urinary bladder B. Kidneys or pancreas C. Liver or spleen D. Ascending aorta

C. Liver or spleen

EMS providers can have the MOST positive impact on mortality and morbidity from abdominal trauma by: A. Contacting medical control immediately B. Performing a careful abdominal assessment C. Recognizing the need for rapid transport D. Initiating fluid resuscitation in the field

C. Recognizing the need for rapid transport

Periumbilical ecchymosis is: A. Usually seen in conjunction with flank bruising and is highly suggestive of injury to the liver or spleen B. Commonly observed in the prehospital setting following blunt force trauma to the abdomen C. Referred to as Cullen sign and may take several hours to develop following abdominal trauma D. Also called Grey Turner sign and manifests almost immediately following blunt abdominal trauma

C. Referred to as Cullen sign and may take several hours to develop following abdominal trauma

The nurse is caring for a child with acute renal failure. Which clinical manifestation should the nurse recognize as a sign of hyperkalemia? a. Dyspnea b. Seizure c. Oliguria d. Cardiac arrhythmia

D ~ Hyperkalemia is the most common threat to the life of the child. Signs of hyperkalemia include electrocardiograph anomalies such as prolonged QRS complex, depressed ST segments, peaked T waves, bradycardia, or heart block. Dyspnea, seizure, and oliguria are not manifestations of hyperkalemia.

For a client with chronic renal failure who is experiencing insomnia, the least helpful strategy would be a. establishing a pre-sleep quiet time. b. planning on a standard time to go to bed. c. setting up a bedtime routine. d. taking an over-the-counter sedative drug.

D ~ Hypnotics and sedatives must be used cautiously because these drugs may alter mentation and may not be adequately cleared by the failing kidneys.

All of the following are examples of cervical-spine injuries that can result from a diving accident except: a. excessive extension b. compression c. excessive flexion d. lateral bending

D

If a patient is found on her back with arms extended above the head, this may indicate a ___ spine injury. a. thoracic b. lumbar c. sacral d. cervical

D

Prior to and after immobilization, the EMT should assess: a. pulses in all extremities b. motor function in all extremities c. sensation in all extremities d. all of these

D

Which of the following would not create a high index of suspicion of a spine injury? a. motor vehicle or motorcycle collisions b. falls that cause open fractures to the ankles c. trauma patients who are found unconscious d. a fall from two times the patient's height

D

Within moments of your arrival at the side of an approximately 20 year old male trauma patient who was found unconscious at the bottom of a stairway. He regains consciousness. The most reliable sign of spinal cord injury in the conscious patient is: a. pain with movement b. impaired breathing c. tenderness on the spine d. paralysis of the extremities

D

You are treating a 35 year old female who has an injury to one of her spinal vertebrae. Based on the frequency of injury, it is most likely one of the: a. lumbar and sacral b. thoracic and cervical c. coccygeal and thoracic d. cervical and lumbar

D

You are treating a patient who fell backward and struck his head. You suspect that he is developing increased ICP. The time it takes to develop the symptoms from an increased ICP depend on: a. the rate of bleeding into the head b. the location of the bleed c. the age of the patient d. all of these are important factors

D

You are treating a patient who has a steel rod penetrating the skull. You should: a. shorten lengthy objects, using any available tools b. elevate the patient's legs immediately c. remove the object and quickly control the bleeding d. stabilize the object with bulky dressings

D

A client had a kidney transplant and is doing well, except for being concerned that the spouse does not seem happy about it. The assessment by the nurse that would yield the most helpful information is to ask the a. client what hobbies and activities they enjoy together. b. client why he/she thinks the spouse is acting that way. c. spouse how he/she feels about the client's progress. d. spouse what his/her role was while the client was ill.

D ~ After a kidney transplant, the client must incorporate the new kidney and better functional status into his or her self-image. Family members must also adapt. For both client and family, role changes occur that require adaptation. Family members may no longer feel needed if they took care of the client. Asking the spouse what his/her role was during the client's illness will give the nurse information about the spouse's role and the nurse can then start a discussion of role adaptation.

The nurse teaching a client about continuous ambulatory peritoneal dialysis (CAPD) would include the information that a. a small, lightweight pump must be carried in a pocket or on a belt. b. CAPD eliminates the need for strict aseptic technique when handling the catheter. c. the procedure involves instilling 250 to 500 ml of fluid at a time. d. there are four daily cycles with an 8-hour dwell for one cycle during the night.

D ~ CAPD usually uses four dialysis cycles every 24 hours, including an 8-hour dwell overnight. There is still the need for asepsis.

To help the peritoneal dialysis client who is complaining of low back pain associated with increased weight in the abdomen, the nurse would suggest a. lying down as much as possible. b. performing specified exercises. c. reducing voluntary fluid intake. d. walking on surfaces with gradual inclines.

D ~ Low back pain may develop with continuous dialysis procedures because the abdominal weight affects posture. Appropriate exercises may help relieve this problem.

An emergency department nurse is caring for a client who has died from a suspected homicide. Which action should the nurse take? a. Remove all tubes and wires in preparation for the medical examiner. b. Limit the number of visitors to minimize the family's trauma. c. Consult the bereavement committee to follow up with the grieving family. d. Communicate the client's death to the family in a simple and concrete manner.

D ~ When dealing with client's and families in crisis, communicate in a simple and concrete manner to minimize confusion. Tubes must remain in place for the medical examiner. Family should be allowed to view the body. Offering to call for additional family support during the crisis is suggested. The bereavement committee should be consulted, but this is not the priority at this time.

A nurse prepares to discharge an older adult client home from the emergency department (ED). Which actions should the nurse take to prevent future ED visits? (SATA) a. Provide medical supplies to the family. b. Consult a home health agency. c. Encourage participation in community activities. d. Screen for depression and suicide. e. Complete a functional assessment.

D, E ~ Due to the high rate of suicide among older adults, a nurse should assess all older adults for depression and suicide. The nurse should also screen older adults for functional assessment, cognitive assessment, and risk for falls to prevent future ED visits.

You are caring for a patient who experienced blunt abdominal trauma. The patient is conscious, but restless. Her respirations are rapid and shallow and her pulse is rapid and weak. What will maximize this patients chances of survival. A. Aggressive airway support, a detailed physical exam at the scene, transport to the closest hospital, and IV therapy performed en route B. Orotracheal intubation, ventilation assistance, 2 to 3 L of IV fluid at the scene, and rapid transport to a trauma center C. Administering supplemental oxygen, administering crystalloid IV fluids at the scene, and rapidly transporting to a trauma center D. Basic airway and circulation support at the scene, prompt transport to a trauma center, and IV fluid boluses as needed en route

D. Basic airway and circulation support at the scene, prompt transport to a trauma center, and IV fluid boluses as needed en route

Anatomically, the abdominal cavity extends from the: A. Umbilicus to the pelvis B. Fifth rib to the pelvis C. Nipple line to the diaphragm D. Diaphragm to the pelvis

D. Diaphragm to the pelvis

Generalized abdominal pain following rupture of a hollow organ is MOST suggestive of: A. Inflamation of deep nerve endings B. Severe intraabdominal bleeding C. Gas accumulation in the peritoneum D. Diffuse peritoneal contamination

D. Diffuse peritoneal contamination

The MOST frequent presentation of blunt renal trauma is: A. Pelvic pain and oliguria B. Pelvic pain and tachycardia C. Low back pain and anuria D. Flank pain and hematuria

D. Flank pain and hematuria

Grey Turner sign is defined as ecchymosis to the _________ and is indicative of _________. A. Back, traumatic aortic dissection B. Umbilicus, peritoneal bleeding C. Epigastrium, stomach rupture D. Flank, retroperitoneal bleeding

D. Flank, retroperitoneal bleeding

Following blunt force trauma to the lower right rib cage, a 40 year old woman presents with restlessness, tachycardia, and unlabored tachypnea. You should be MOST concerned that she has a: A. Pneumothorax B. Splenic rupture C. Pyloric injury D. Liver injury

D. Liver injury

Penetrating abdominal trauma MOST commonly results from: A. High-powered rifles or military weapons B. Flying debris following an explosion C. Crush forces that separate the abdominal wall D. Low velocity gunshot or stab wounds

D. Low velocity gunshot or stab wounds

When blood is released into the peritoneal cavity: A. The abdomen almost immediately becomes grossly distended B. Blood pressure falls with as little as 500ml of internal blood loss C. It is most often the result of blunt force trauma to the pancreas D. Nonspecific signs such as tachycardia and hypotension may occur

D. Nonspecific signs such as tachycardia and hypotension may occur

The major complication associated with hollow organ injury is: A. Massive internal hemorrhage and profound shock B. Immediate death secondary to a massive infection C. Delayed treatment due to the absence of external signs D. Peritonitis caused by rupture and spillage of toxins.

D. Peritonitis caused by rupture and spillage of toxins.

What are the normal Creatinine Clearance values?

Men 107-139 mL/min Women 87-107 mL/min

What is the normal Glomerular Filtration Rate (GFR)?

Men >130 mL/min/m2 Women >120 mL/min/m2

On maximal expiration the diaphragm may be: a. As low as the ninth intercostal space anteriorly b. As high as the fourth intercostal space anteriorly c. As low as the eleventh intercostal space anteriorly d. As high as the second intercostal space anteriorly

b. As high as the fourth intercostal space anteriorly

List the GFR rates in the different stages of renal failure.

Stage 1 = <90 mL/min Stage 2 = <60 mL/min Stage 3 = <45 mL/min Stage 4 = <30 mL/min Stage 5 = <15 mL/min

An 85 year old woman presents with acute lower abdominal pain and bloody diarrhea for 1 day. On exam her abdomen is slightly distended with diffuse tenderness. Her vital signs are stable. A plain film X-ray shows "thumbprinting" suggesting the diagnosis of: A. Volvulus B. Intussusception C. Invasive gastroenteritis D. Ischemic colitis

The answer is D. Thumbprinting represents local areas of swelling in the bowel mucosa caused by submucosal edema and hemorrhage and suggests ischemic colitis.

Which of the following bacteria does NOT produce bloody diarrhea? A. Yersinia enterocolitica B. Clostridium perfringens C. Campylobacter enteritis D. Escherichia coli

The answer is B. Clostridium perfringens is the most common cause of food poisoning in the United States. Patients ingest heat-resistant spores of C. pergringens which produce an enterotoxin in the GI tract. Campylobacter, E. coli 0157, Salmonella and Yersinia are all invasive bacteria that can cause bloody enteritis.

Which of the following is NOT part of the prehospital examination or the patient with suspectedabdominal trauma? a. Asking the patient about abdominal pain first, then palpating the abdomen in all four quadrants b. Auscultating bowel sounds c. Checking for stability of the pelvis d. Assessment of the thorax for injury

b. Auscultating bowel sounds

A nurse is caring for a client who was brought to the ER following displacement from their home due to a flood. When assessing the client, which of the following clinical manifestations would the nurse anticipate are related to the experience of trauma? SATA a. Anxiety b. Sleep disturbance c. Anger d. Depression e. Hallucinations f. Elevated mood

a, b, c, d

A nurse is assigned to triage clients following an explosion at an oil refinery. Which of the following symptoms are consistent with a trauma response involving the SNS? SATA a. Increased heart rate b. Shallow breathing c. Muscle tension d. Immobility e. Anxiety f. Fatigue

a, b, c, e

A nurse is working with a local crisis response team to evaluate students following a school shooting. After ensuring the safety of the students, which of the following trauma-informed approaches should the team take next? a. Establish a supportive environment that facilitates trust and transparency b. Provide resources to students for trauma support and recovery c. Explain what trauma is and the symptoms of trauma d. Report any students exhibiting inability to cope with their traumatic event

a. Establish a supportive environment that facilitates trust and transparency

Which of the following is the primary prehospital concern with a simple, isolated fracture of the fifth rib in the right posterior-axillary line? a. Hypoventilation b. Pneumonia c. Liver contusion d. Hemorrhage

a. Hypoventilation

Which of the following guidelines applies to prehospital fluid resuscitation of hypotensive patients with intraabdominal hemorrhage? a. In most cases fluid administration should be limited to 3 liters. b. IV access should be obtained using a salien lock, but fluid resuscitation is contraindicated in the prehospital setting c. Fluid administration rate should be titrated to maintina systlic blood pressure of 60 mmHg. d. IV access is only necessary if the use of PASG fails to improve the patient's clinical condition.

a. In most cases fluid administration should be limited to 3 liters.

An individual is struck in the left ventricle with a high-velocity projectile. As compared to low-velocity penetrating trauma, you should have a higher index of suspicion for: a. Pericardial tamponade b. Ventricular rupture c. Blunt cardiac injury d. Simple penetrating injury

a. Pericardial tamponade

Which of the following is a complication of positive-pressure ventilation in the patient with significant chest trauma? a. Reduced cardiac output b. Pulmonary contusion c. Atelectasis d. Exacerbation of flail chest

a. Reduced cardiac output

You have just inserted a large-bore catheter into the chest of a patient with a tension pneumothorax and received a return of air. Which of the following should NOT be done? a. Remove the catheter. b. Leave the catheter in place, and create a flutter valve. c. Leave the catheter in place and open to air. d. Insert a second, or even a third, catheter if the patient is symptomatic, despite the release of air.

a. Remove the catheter.

Which of the following is TRUE of pulmonary contusion? a. Signs and symptoms generally develop gradually. b. The primary pathophysiology is that the alveoli are filled with blood. c. Pulmonary contusion is typically an isolated injury. d. Pulmonary contusion results in paradoxical motion of the chest wall.

a. Signs and symptoms generally develop gradually.

Which of the following statements is NOT true of pericardial tamponade? a. The systolic blood pressure increases significantly on inspiration. b. It is most often associated with penetrating trauma. c. As little as 150 ml of blood can cause pericardial tamponade. d. The pathophysiology results in increased venous pressure and decreased cardiac output.

a. The systolic blood pressure increases significantly on inspiration.

A nurse is caring for a newly admitted client who has experienced a traumatic event. Which of the following 2 client findings require the nurse to immediately follow-up? a. Client's reluctance to speak to friends b. Client's statement regarding harming others c. Lack of physical injury to the client d. Client's statement regarding feelings when awakening e. Client's inability to relax

b, d

Which of the following are the most commonly fractured ribs? a. 5 to 10 b. 4 to 8 c. 1 to 3 d. 7 to 12

b. 4 to 8

Which of the following statements concerning blunt thoracic trauma in the pediatric population is most accurate? a. Children are less likely than adults to suffer either rib fractures or organ injury. b. Children are less likely than adults to suffer rib fractures but more likely to have significant organ injury. c. Children are more likely than adults to suffer both rib fracture and organ injury. d. Children are more likely than adults to suffer rib fractures but less likely to suffer significant organ injury.

b. Children are less likely than adults to suffer rib fractures but more likely to have significant organ injury.

Which of the following occurs during the onset of inspiration? a. Intrathoracic pressure increases and venous return to the heart is facilitated. b. Intrathoracic pressure decreases and venous return to the heart is facilitated. c. Intrathoracic pressure increases and venous return to the heart is impeded. d. Intrathoracic pressure decreases and venous return to the heart is impeded.

b. Intrathoracic pressure decreases and venous return to the heart is facilitated.

Which of the following is LEAST likely to be a sign of an open pneumothorax? a. Large, open thoracic wound. b. Jugular vein distention c. Frothy blood around the opening d. Dyspnea

b. Jugular vein distention

The central area in the thorax that contains the heart, great vessels, trachea, and esophagus is the: a. Pulmonary hilum b. Mediastinum c. Carina d. Hemothorax

b. Mediastinum

Which of the following has the greatest likelihood of resulting in an open pneumothorax? a. Open defects that are one-quarter the size of the trachea or larger b. Open defects that are two-thirds the size of the trachea or larger c. Any opening between the pleural cavity and the atmosphere d. Open defects that are larger in diameter than the trachea

b. Open defects that are two-thirds the size of the trachea or larger

Your patient is a 27-year-old male with one stab wound at the fifth intercostal space posteriorly, on the right. He is ambulatory at the scene but dyspneic and has air movement at the site of the injury. Which of the following should you do first? a. Cover the wound with your gloved hand. b. Prepare an occlusive dressing. c. Perform a needle thoracostomy. d. Apply oxygen by nonrebreather.

b. Prepare an occlusive dressing.

A nurse is providing parenting education to a group of new parents at the area community center. Which of the following types of trauma prevention is the nurse providing? a. Secondary prevention b. Primary prevention c. Primordial prevention d. Tertiary prevention

b. Primary prevention

Your patient is a 38-year-old male who was pinned beneath the frame of a vehicle when it slipped off the makeshift jacks he was using to elevate it. The patient's brother thinks he may have been trapped for up to 20 minutes. The rescue unit is preparing to use airbags to lift the vehicle off the patient. Which of the following medications could you consider giving this patient? a. Potassium chloride b. Sodium bicarbonate c. Magnesium sulfate d. Calcium chloride

b. Sodium bicarbonate

Your patient is a 38-year-old male who was pinned beneath the frame of a vehicle when it slipped off the makeshift jacks he was using to elevate it. The patient's brother thinks he may have been trapped for up to 20 minutes. The rescue unit is preparing to use airbags to lift the vehicle off the patient. Which of the following medications could you consider giving this patient? Select one: a. Magnesium sulfate b. Sodium bicarbonate c. Potassium chloride d. Calcium chloride

b. Sodium bicarbonate

A nurse has attended an in-service regarding nursing care for clients who have experienced trauma. Which of the following statements by the nurse represent an understanding of trauma? a. "Trauma is usually a series of events rather than a one-time occurrence." b. "Trauma is a specific term used to describe visible wounds that a client has experienced." c. "Trauma is a broad term that refers to a person's physical, psychological, or emotional response to an adverse event." d. "Trauma is predominantly experienced in adulthood as children cannot recognize trauma."

c. "Trauma is a broad term that refers to a person's physical, psychological, or emotional response to an adverse event."

Thoracic trauma accounts for approximately ________ percent of mortality from trauma? a. 45 to 50 b. 75 to 80 c. 20 to 25 d. 10 to 15

c. 20 to 25

The trachea divides into the right and left mainstem bronchi at the: a. Hilum b. Thoracic inlet c. Carina d. Lingual

c. Carina

Which of the following best describes the mechanism of blunt thoracic trauma associated with blast injuries? a. Compression and decompression b. Compression c. Deceleration d. Acceleration

c. Deceleration

Abdominal trauma should be suspected with penetrating thoracic wounds below the ________ rib anteriorly and the ________ rib posteriorly. a. Second, tenth b. Second, fifth c. Fourth, sixth d. Fourth, ninth

c. Fourth, sixth

The finding of jugular venous distension in the patient with thoracic trauma is LEAST likely to be associated with which of the following? a. Pericardial tamponade b. Tension pneumothorax c. Hemothorax d. Traumatic asphyxia

c. Hemothorax

Your patient is a 24-year-old male who was struck just below the left scapula with a 3-inch-diameter metal pipe. He is awake but having difficulty breathing. His pulse is 112 at the radial artery, and his respiratory rate is 28 per minute and shallow. His breath sounds are present bilaterally but diminished on the left. He has a blood pressure of 108/68. The patient is coughing up some bloody sputum. He has no other complaints, and a rapid trauma survey reveals no additional life-threatening injuries. Which of the following represents the best sequence of intervention for this patient? a. Begin transport immediately, positive pressure ventilation, a large-bore IV of isotonic solution to maintain a systolic blood pressure of 120 mmHg or greater b. Positive-pressure ventilation, a large-bore IV of normal saline solution at a keep-open rate, transport c. High-concentration oxygen by nonrebreathing mask, begin transport

c. High-concentration oxygen by nonrebreathing mask, begin transport, a 16-gauge IV at a keep-open rate

Your patient is an 80-year-old male who was the unrestrained driver of a vehicle without airbags that was involved in a frontal collision with a parked car. Your assessment reveals that he is dyspneic, tachypneic, and tachycardic. He is awake but unable to respond to questions. There are no obvious signs of injury to the head or neck. The patient has paradoxical movement of the sternum with breathing, along with crepitus and subcutaneous air noted on palpation. Chest excursion is limited, and the patient has cyanosis of his lips, ears, and nail beds. Which of the following is MOST needed in this patient? a. Being placed in a prone position to stabilize the chest wall b. Application of bulky dressings over the site of paradoxical motion c. Intubation and positive-pressure ventilation d. Infusion of isotonic crystalloid solution using a large-bore IV

c. Intubation and positive-pressure ventilation

Which of the following most accurately characterizes simple pneumothorax? a. Untreated, it will lead to mediastinal shift and compression of the contralateral lung. b. It results from the creation of a one-way valve that continues to allow air into, but not out of, the pleural cavity. c. It is a problem of ventilation/perfusion mismatch. d. It results from air entering the pleural cavity through a defect in the chest wall.

c. It is a problem of ventilation/perfusion mismatch.

Which of the following best describes the incidence of pericardial tamponade? a. It occurs in 2 percent of all trauma patients. b. It occurs in 10 to 15 percent of patients with serious chest trauma. c. It occurs in less than 2 percent of all patients with serious chest trauma. d. It occurs in 10 to 15 percent of all trauma patients.

c. It occurs in less than 2 percent of all patients with serious chest trauma.

Which of the following best describes the epidemiology of sternal fracture? a. High incidence, high mortality b. High incidence, low mortality c. Low incidence, high mortality d. Low incidence, low mortality

c. Low incidence, high mortality

Which of the following may improve breathing in the patient with isolated rib fractures? a. Nitrous oxide b. Taping circumferentially around the chest c. Morphine sulfate d. None of the above

c. Morphine sulfate

A nurse is providing care for an adolescent who sustained injuries in assault. Which of the following actions should the nurse take first? a. Identify the adolescent's coping strategies and skills b. Explore the adolescent's feelings about the assault c. Provide a safe, secure environment for the adolescent d. Provide the adolescent with information on support groups

c. Provide a safe, secure environment for the adolescent

You are treating a patient whose open chest wound has been sealed by EMTs on the scene before your arrival. During transport the patient becomes more dyspneic, tachycardic, and hypotensive. There are no breath sounds on the affected side, and the patient has JVD. Which of the following is the best action? a. Perform a needle thoracostomy at the fourth intercostal space in the midaxillary line. b. Perform a needle thoracostomy at the second intercostal space in the midclavicular line. c. Remove the dressing, and see if the patient's clinical status improves, then replace the dressing. d. Reinforce the dressing with additional tape, using tincture of benzoin, if necessary, to improve the seal

c. Remove the dressing, and see if the patient's clinical status improves, then replace the dressing.

A nurse is caring for a client who has depression, diabetic polyneuropathy, and significant neuropathic pain. The nurse hears a PA say "they are admitted frequently and always report being in pain. I think they are a drug seeker" which of the following responses should the nurse make? a. "You certainly call things like you see them. I am going to ignore you said that!" b. "Yes, this client is always in pain. You should remember that it is our job to take care of people like them." c. "What is bothering you? Just keep your comments and opinions to yourself." d. "It is not appropriate to stereotype clients. It seems like you may have bias which could affect client care."

d. "It is not appropriate to stereotype clients. It seems like you may have bias which could affect client care."

A nurse has attended an in-service education regarding trauma-informed care approach. Which of the following statements by the nurse reflects an accurate description for the goal of trauma-informed approach? a. "A trauma-informed approach to care is a process of steps which evaluates injury to determine priority of care." b. "Nurses should focus on immediate client care rather than the trauma that has happened to the client." c. "Trauma-informed care is most important in the emergency department and with first responders. They see the most trauma." d. "Nurses should understand the effects of trauma and structure client care to promote positive outcomes."

d. "Nurses should understand the effects of trauma and structure client care to promote positive outcomes."

Your patient was the unrestrained driver of a motor vehicle without airbags. The vehicle struck a large utility pole at about 45 miles per hour. Your patient has a contusion over his chest and upper abdomen consistent with the shape of the steering wheel. You should suspect which of the following types of injury in this patient? a. Deceleration b. Compression and acceleration c. Compression d. Compression and deceleration

d. Compression and deceleration

Which of the following findings differentiates a simple pneumothorax from a tension pneumothorax? a. Absent breath sounds on the affected side b. An open defect in the chest wall c. Decreased breath sounds on the affected side d. Hemodynamic compromise

d. Hemodynamic compromise

Which of the following is the primary concern in the patient with a hemothorax? a. Increased intrathoracic pressure b. Mediastinal shift c. Atelectasis d. Hypovolemia

d. Hypovolemia

Which of the following best describes the finding of tracheal deviation in the trauma patient? a. It is a contraindication to needle thoracostomy in tension pneumothorax. b. Its absence rules out tension pneumothorax. c. It is the earliest sign of tension pneumothorax. d. It is not reliably present in patients with tension pneumothorax.

d. It is not reliably present in patients with tension pneumothorax.

Which of the following best describes the incidence of pericardial tamponade? a. It occurs in 10 to 15 percent of all trauma patients. b. It occurs in less than 2 percent of all patients with serious chest trauma. c. It occurs in 10 to 15 percent of patients with serious chest trauma. Incorrect d. It occurs in 2 percent of all trauma patients.

d. It occurs in 2 percent of all trauma patients.

Another name for an open pneumothorax is: a. Tension pneumothorax b. Hemopneumothorax c. Flail chest d. Sucking chest wound

d. Sucking chest wound

The morbidity associated with simple pneumothorax is primarily due to which of the following? a. Loss of chest wall integrity b. Increased intrathoracic pressure c. Occlusion of pulmonary circulation d. Ventilation/perfusion mismatch

d. Ventilation/perfusion mismatch

The nurse performing intermittent peritoneal dialysis notes that the medical record shows the client has not had a bowel movement for 3 days. The nurse would be careful to assess the client for a. cloudy dialysate output. b. fluid leakage. c. increased thirst. d. reduced catheter outflow.

D ~ Constipation can reduce catheter flow, possibly because peristalsis facilitates outflow.

Regarding gastrointestinal bleeding, which of the following is TRUE? A. The majority of bleeding from diverticula occurs from the right side of the colon B. The most common cause of upper gastrointestinal bleeding in both adults and children is peptic ulcer disease C. The mortality of lower gastrointestinal bleeding is higher than the mortality of upper gastrointestinal bleeding D. Patients with a history of gastrointestinal bleeding almost always bleed again from the same site

The answer is A. There are many specific etiologies that cause gastrointestinal bleeding. In general, however, the mortality of upper gastrointestinal bleeding is higher than lower gastrointestinal bleeding. In adults, the most common cause of upper gastrointestinal bleeding is peptic ulcer disease. In children, it is esophagitis. Unfortunately, it can be difficult to diagnose the source of gastrointestinal bleeding as the bleeding may often stop and start spontaneously or from different sites.

The most common cause of adult upper gastrointestinal (GI) bleeding is: A. Varices B. Peptic ulcer disease (PUD) C. Mallory-Weiss tears D. Esophagitis

The answer is B. The most common causes of upper GI bleeding are (in descending order of frequency): PUD, gastric erosions, varices, Mallory-Weiss tears, esophagitis, and duodenitis.

A 67 year old man with a history of peptic ulcer disease presents to the emergency department complaining of feeling light-headed. On ROS he acknowledges having had black tarry stools for the past 2-3 days. On exam he is noted to be pale with the following vital signs: T 97.3 F, HR 126, BP 92/64, RR 22, and melena is noted on rectal exam. Which of the following is an INCORRECT recommendation regarding the initial management of this patient? A. Type and cross two units of packed red blood cells. B. Place two intravenous lines that are 22-gauge. C. Place the patient on cardiac and oxygen saturation monitors. D. Apply supplemental oxygen. E. Administer normal saline intravenously in 10mg/kg boluses.

The answer is B. The patient is having gastrointestinal bleeding most likely from a peptic ulcer given his history. Urgent first steps in management include placement of two intravenous lines that are larger-bore than 22-gauge (18 gauge or larger size preferred) to enable rapid volume resuscitation, in addition to the oxygen, monitoring, intravenous fluids and preparation of blood products. Patients with an upper GI bleed who remain hemodynamically unstable require urgent consultation with gastroenterology.

A 20 year old man presents to the emergency department with 1 week of intermittent bloody bowel movements associated with crampy abdominal pain, tenesmus, and fecal urgency. He is previously healthy. He is not on medications; nor has he recently traveled. What test will most likely confirm his diagnosis? A. a workup for a bleeding diathesis B. colonoscopy to rule out inflammatory bowel disease C. barium enema to rule out intussusception D. stool culture to rule out invasive bacterial diarrhea

The answer is B. This patient will need a colonoscopy with intestinal biopsy to evaluate for inflammatory bowel disease such as ulcerative colitis and Crohn's disease or other causes of colitis. Appendicitis usually presents with periumbilical pain migrating to the right lower quadrant with associated anorexia, not bloody bowel movements. Intussusception is uncommon after the age of 6. A stool culture should be obtained to rule out bacterial colitis, but his history is less suggestive of this.

The most common cause of intrinsic lower gastrointestinal (GI) bleeding in an adult is: A. Polyps B. Inflammatory bowel disease C. Diverticulosis D. Cancer

The answer is C. Diverticulosis and angiodysplasia account for 80% of lower GI bleeds. In approximately 10% of all patients with GI bleeding, no source of bleeding will be found.

You are treating an 80 you male in whom you suspect a lower GI bleed. Which of these following statements is TRUE regarding the guaiac test? A. A false positive may be caused by ingestion of magnesium-containing antacids B. A false negative may be caused by the presence of chlorophyll C. A false positive may be caused by the presence of methylene blue D. A false negative may be caused by the presence of bromide preparations

The answer is C. Red fruits or meats, methylene blue, chlorophyll, iodide, cupric sulfate and bromide preparations can cause a false positive guaiac test. A false negative guaiac test can be caused by bile or ingestion of magnesium-containing antacids or ascorbic acid. Red Jell-O, tomato sauce, wine, iron therapy and Pepto-Bismol may cause the stool to look bloody when it is not.

A 49 year old presents complaining of 1 day of painful bright red blood per rectum. He has painful bowel movements and streaks of blood appear on the toilet paper. He has had hard stools for two weeks after starting opiate pain medication for a broken arm. He has never had these symptoms before. Based on the patient's history, the physician examining the patient will likely find: A. An internal hemorrhoid B. A nonthrombosed external hemorrhoid C. An anal fissure D. A thrombosed external hemorrhoid

The answer is C. Sudden sharp pain after defecation along with blood on toilet tissue characterizes anal fissures. A thrombosed external hemorrhoid causes painful bleeding on defecation. Usually there is a history of external hemorrhoids and associated itching, swelling, and mucoid drainage. Internal hemorrhoids usually exhibit painless bleeding that may drip into the toilet after defecation. Rectal cancers also have painless bleeding but usually are associated with a change in bowel movement character and other signs and symptoms of malignancy.

The most common cause of lower GI bleeding is: A. Angiodysplasia B. Cancer C. Peptic ulcer disease D. Esophageal varices E. Diverticulosis

The answer is E. Diverticulosis is the most common cause of lower GI bleeding. Angiodysplasia is the more common in young people.

The nurse explains that a cation exchange resin such as Kayexalate will a. decrease diastolic blood pressure. b. stimulate diuresis by osmosis. c. increase appetite by decreasing insulin degradation. d. increase gastrointestinal potassium excretion.

D ~ Hyperkalemia is probably the most dangerous imbalance because of its contribution to cardiac dysrhythmias and arrest. Cation exchange resins such as sodium polystyrene sulfonate (Kayexalate) may be administered orally or rectally to facilitate excretion of potassium from the gastrointestinal (GI) tract.

A client with renal failure has an order to infuse dopamine (Intropin) to activate the dopamine receptors in the kidney. The nurse would set the infusion rate for a. 21 to 25 mg/kg/minute. b. 11 to 20 mg/kg/minute. c. 6 to 10 mg/kg/minute. d. 1 to 5 mg/kg/minute.

D ~ Low doses (1 to 5 mg/kg/minute) of dopamine hydrochloride (Intropin) may be given to activate dopamine receptors in the kidney.

The nurse is caring for an adolescent who has just started dialysis. The child seems always angry, hostile, or depressed. The nurse should recognize that this is most likely related to: a. neurologic manifestations that occur with dialysis. b. physiologic manifestations of renal disease. c. adolescents having few coping mechanisms. d. adolescents often resenting the control and enforced dependence imposed by dialysis.

D ~ Older children and adolescents need control. The necessity of dialysis forces the adolescent into a dependent relationship, which results in these behaviors. These are a function of the child's age, not neurologic or physiologic manifestations of the dialysis. Feelings of anger, hostility, and depression are functions of the child's age, not neurologic or physiologic manifestations of the dialysis. Adolescents do have coping mechanisms, but they need to have some control over their disease management.

Which is an advantage of peritoneal dialysis? a. Treatments are done in hospitals. b. Protein loss is less extensive. c. Dietary limitations are not necessary. d. Parents and older children can perform treatments.

D ~ Peritoneal dialysis is the preferred form of dialysis for parents, infants, and children who wish to remain independent. Parents and older children can perform the treatments themselves. Treatments can be done at home. Protein loss is not significantly different. The dietary limitations are necessary, but they are not as stringent as those for hemodialysis.

The client with chronic renal failure who would not be a candidate for peritoneal dialysis is a client a. who has diabetes mellitus. b. who is a 10-year-old child. c. with severe cardiovascular disease. d. with severe respiratory disease.

D ~ Relative contraindications to peritoneal dialysis include obesity, history of ruptured diverticuli, abdominal disease, respiratory disease, recurrent episodes of peritonitis, abdominal malignancies, severe vascular disease, and extensive abdominal surgery with drains or tubes, which may increase risk of infection.

Which is the most common cause of acute renal failure in children? a. Pyelonephritis b. Tubular destruction c. Urinary tract obstruction d. Severe dehydration

D ~ The most common cause of acute renal failure in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. Pyelonephritis and tubular destruction are not common causes of acute renal failure. Obstructive uropathy may cause acute renal failure, but it is not the most common cause.

For the nurse trying to assist a client with renal failure to stay within the prescribed fluid restriction, the least helpful strategy would be to a. give medication at mealtime. b. provide frequent oral hygiene. c. put allotted water into a spray bottle. d. use ice chips liberally instead of fluids.

D ~ The nurse helps the client stay within the prescribed fluid restriction with careful oral hygiene and judicious use of ice chips, lip ointments, and appropriate diversionary activities. Placing the allotted water in a spray bottle may help to spread out the amount taken. To conserve fluids for the client with renal failure, medications are administered with meals, if possible.

While caring for a client in the oliguric phase of ARF, the nurses plan of care should include a. encouraging fluid intake to prevent dehydration. b. increasing the client's protein intake to prevent muscle wasting. c. maintaining reverse isolation to prevent infection. d. meticulous skin care to prevent skin breakdown.

D ~ The poor systemic nutrition and edema accompanying renal failure may cause skin breakdown. Meticulous skin care, frequent turning, and special mattresses are very important. Clients may well be on fluid restrictions. They do not need reverse isolation. Protein is often restricted as well.

A client has been found to be an acceptable candidate for a kidney transplant. The nurse counsels the client and family that the client now faces the greatest impediment to renal transplantation, which is a. high potential for rejection. b. high risk for infection. c. insufficient financial resources. d. lack of sufficient donor organs.

D ~ The primary factor limiting the number of transplants done is the availability of kidneys.

Which of the following assessment findings is MOST suggestive of intra-abdominal hemorrhage? A. Nausea and vomiting B. Palpable pain C. Diffuse tenderness D. Signs of shock

D. Signs of shock

Referred pain to the left shoulder following blunt abdominal trauma should lead you to suspect injury to the: A. Intestines B. Stomach C. Diaphragm D. Spleen

D. Spleen

A client had an episode of acute renal failure after heart surgery but seems to have recovered now. What is an important health promotion strategy the nurse could teach the client? The nurse should teach the client to a. avoid aminoglycosides and IVP dye in the future. b. drink lots of fluids on an ongoing basis. c. have a BUN and creatinine drawn every 6 months. d. monitor his/her temperature daily.

A ~ An important health promotion strategy to help prevent renal failure is to avoid nephrotoxic agents, including aminoglycosides and IVP dye.

The nurse notes in the first few exchanges during peritoneal dialysis of a client that the effluent is tinged pink. The nurse's most appropriate action is to a. continue the dialysis. b. notify the physician. c. send a specimen for culture. d. stop the dialysis immediately.

A ~ Bloody effluent is usually insignificant and disappears spontaneously.

The charge nurse in the intensive care unit is making client assignments. Which client should the charge nurse assign to the graduate nurse who has just finished the 3 month orientation? 1. The client with an abnormal peritoneal resection who has a colostomy 2. The client diagnosed with pneumonia who has acute respiratory distress syndrome 3. The client with a head injury developing disseminated intravascular coagulation 4. The client admitted with a gunshot wound who has an H&H of 7 and 22

1. This is major surgery but has a predictable course with no complications identified in the stem and a colostomy is expected with this type of surgery. The graduate nurse could be assigned this patient.

What is the normal lab value for serum PHOSPHORUS?

2.4-4.1 mg/dL

What is the normal lab value for Urine Potassium?

25-100 mEq/L/day

Which collaborative treatment would the nurse anticipate in the client diagnosed with DIC? 1. Administer oral anticoagulants 2. Prepare for plasmapheresis 3. Administer fresh frozen plasma 4. Calculate the intake and output

3. Fresh frozen plasma and platelet concentrates are administered to restore clotting factors and platelets

What is the normal lab value for serum ALBUMIN?

3.5-5.5 g/dL

What is the Normal Osmolality of Urine?

300-900 mOsm/kg

Which client would be most at risk for developing disseminated intravascular coagulation (DIC)? 1. A 35 year old pregnant client with placenta previa 2. A 42 year old client with a pulmonary embolus 3. A 60 year old client receiving hemodialyasis 3 days a week 4. A 78 year old client with septicemia

4. DIC is a clinical syndrome that develops as a complication of a wide variety of other disorders, with sepsis being the most common cause of DIC

The nurse writes a diagnosis of "potential for fluid volume deficit related to bleeding" for a client diagnosed with DIC. Which would be an appropriate goal? 1. The client's clot formations will resolve in two days 2. The saturation of the client's dressings will be documented 3. The client will use lemon-glycerin swabs for oral care 4. The client's urine output will be > 30 mL per hour

4. The problem is addressing the potential for hemorrhage, and a urine output of greater than 30 mL/hr indicates the kidneys are being adequately perfused and the body is not in shock.

What is the normal lab value for Urine pH?

4.8-7.5

The nurse caring for a client in the diuretic phase of acute renal failure (ARF) should assess for manifestations of a. dehydration. b. hypertension. c. hypokalemia. d. metabolic acidosis.

A ~ A gradual or abrupt return to glomerular filtration and leveling of blood urea nitrogen (BUN) level signal the diuretic phase. Urine output may be 1000 ml/day, which may lead to dehydration.

Which clinical manifestation would be seen in a child with chronic renal failure? a. Hypotension b. Massive hematuria c. Hypokalemia d. Unpleasant uremic breath odor

D ~ Children with chronic renal failure have a characteristic breath odor resulting from the retention of waste products. Hypertension may be a complication of chronic renal failure. With chronic renal failure, little or no urinary output occurs. Hyperkalemia is a concern in chronic renal failure.

A client has been on dialysis for 6 weeks. The family is complaining that instead of feeling grateful at this second chance at life, the client has become irritable with them and seems depressed. The most helpful response by the nurse would be a. Depression is very common at this time; it is hard to adapt to the losses she feels. b. I am surprised that your loved one doesn't feel happier about being alive. c. This must be very hard on you for your loved one to be so unappreciative. d. We can arrange a psychiatric consultation if you think it will help.

A ~ Clients are often happy and grateful as they start dialysis and begin to feel well for the first time in a long time. But as the time goes by and the implication of the permanent change to their lives becomes apparent, it is common for them to have psychosocial difficulties, including depression. In fact, the suicide rate for dialysis clients is estimated to be 100 times that of the general public. The other three options not only do not give helpful information about what is happening but also are poor examples of therapeutic communication.

Three months after a kidney transplant, a client develops fever, graft tenderness, malaise, and elevated white blood cell count. The nurse conducts further assessments based on understanding that the likely cause of these manifestations is a. graft rejection. b. influenza. c. pyelonephritis. d. urinary tract infection.

A ~ Clinical manifestations of renal transplant rejection include fever, graft tenderness, anemia, and malaise.

A client with ARF is allowed a specific amount of fluid by mouth during 24 hours in order to a. compensate for insensible and measured fluid losses during the previous 24 hours. b. equal the expected urine output for the next 24 hours. c. prevent hyperkalemia, which could lead to serious cardiac dysrhythmia. d. prevent the development of complicating hypostatic pneumonia.

A ~ Fluid replacement volumes are usually calculated on the basis of some fraction of the previous days urine output plus an amount (e.g., 400 ml) to account for the usual insensible loss that occurs during a 24-hour period.

A client with oliguric ARF would exhibit a. a BUN/creatinine ratio of 30:1. b. hematuria. c. proteinuria. d. a urine specific gravity of 1.001.

A ~ In oliguric ARF, urine production usually falls below 400 ml/day. The BUN/creatinine ratio is significantly elevated, reaching levels of 10:1 to 40:1.

The nurse explains to a client's family that the most common overall manifestation of ARF is that a. expected urine output is altered. b. the client's breath develops a fruity odor. c. urine specific gravity is greater than 1.040. d. urine develops a root beer color.

A ~ The most common overall manifestation of ARF is alteration in the expected urine output. Usually this is oliguria or anuria, although polyuric ARF accounts for 30% of cases.

The nurse is conducting an admission assessment on a school-age child with acute renal failure. Which are the primary clinical manifestations the nurse expects to find with this condition? a. Oliguria and hypertension b. Hematuria and pallor c. Proteinuria and muscle cramps d. Bacteriuria and facial edema

A ~ The principal feature of acute renal failure is oliguria; hypertension is a nonspecific clinical manifestation. Hematuria and pallor, proteinuria and muscle cramps, and bacteriuria and facial edema are not principal features of acute renal failure.

The nurse explains to a client with chronic renal failure that the rationale for receiving calcium carbonate is that it a. binds with phosphorus to eliminate it from the body. b. binds with potassium to eliminate it from the body. c. helps prevent constipation. d. helps prevent ulcer formation.

A ~ To improve excretion of phosphorus, the client with chronic renal failure is given calcium-based phosphate binders, such as calcium acetate or calcium carbonate.

The nurse is conducting peritoneal dialysis for a client with renal failure and finds the drainage tubing has no outflow. The priority action that the nurse would take is to a. apply a 5-pound sandbag to the abdomen. b. check the tubing for kinks or obstruction. c. notify the physician about the problem. d. try a more concentrated dialysate solution.

B ~ If fluid does not drain properly during peritoneal dialysis, the nurse should check the system for kinks or other obstructions. If there is no obvious problem, then the nurse should notify the physician. The other two options are not related.

A school-age child with chronic renal failure is admitted to the hospital with a serum potassium level of 5.2 mEq/L. Which prescribed medication should the nurse plan to administer? a. Spironolactone (Aldactone) b. Sodium polystyrene sulfonate (Kayexalate) c. Lactulose (Cephulac) d. Calcium carbonate (Calcitab)

B ~ Normal serum potassium levels in a school-age child are 3.5 to 5 mEq/L. Sodium polystyrene sulfonate is administered to reduce serum potassium levels. Spironolactone is a potassium sparing diuretic and should not be used if the serum potassium is elevated. Lactulose is administered to reduce ammonia levels in patients with liver disease. Calcium carbonate may be prescribed as a calcium supplement, but it will not reduce serum potassium levels.

Calcium carbonate is given with meals to a child with chronic renal disease. The purpose of this is to: a. prevent vomiting. b. bind phosphorus. c. stimulate appetite. d. increase absorption of fat-soluble vitamins.

B ~ Oral calcium carbonate preparations combine with phosphorus to decrease gastrointestinal absorption and the serum levels of phosphate. Serum calcium levels are increased by the calcium carbonate, and vitamin D administration is necessary to increase calcium absorption. Calcium carbonate does not prevent vomiting, stimulate appetite, or increase the absorption of fat-soluble vitamins.

Which statement is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. It is the preferred means of renal replacement therapy in children. c. Children can receive kidneys only from other children. d. The decision for transplantation is difficult because a relatively normal lifestyle is not possible.

B ~ Renal transplant offers the opportunity for a relatively normal life and is the preferred means of renal replacement therapy in end-stage renal disease. Renal transplantation can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes. Renal transplantation affords the child a more normal lifestyle than dependence on dialysis.

The nurse is conducting teaching for an adolescent being discharged to home after a renal transplant. The adolescent needs further teaching if which statement is made? a. I will report any fever to my primary health care provider. b. I am glad I only have to take the immunosuppressant medication for two weeks. c. I will observe my incision for any redness or swelling. d. I wont miss doing kidney dialysis every week.

B ~ The immunosuppressant medications are taken indefinitely after a renal transplant, so they should not be discontinued after two weeks. Reporting a fever and observing an incision for redness and swelling are accurate statements. The adolescent is correct in indicating dialysis will not need to be done after the transplant.

A client is complaining about the decrease in quality of life experienced since the client started dialysis. Using recent research to guide suggestions, the nurse counsels the client to a. become more active in care planning. b. engage in regular exercise. c. start attending church if not already going. d. try to stay active in the community.

B ~ While all suggestions might help improve quality of life for the client undergoing dialysis, a recent research study with 226 participants identified exercise activity as the most important predictor of quality of life approximately 60 days after starting dialysis.

A client is at a follow-up appointment and confesses that she does not take medications as prescribed. When planning a teaching strategy to address this problem, the nurse understands that clients often do not adhere to self-care guidelines because (SATA) a. a good understanding of the consequences leads them to skip meds. b. clients may believe they no longer need the medications. c. side effects may be disruptive and unpleasant. d. the economic costs are too high for them to absorb.

B, C, D ~ There are many reasons for noncompliance, including options b, c, and d. Failure to follow prescribed guidelines is a major problem and the nurses challenge is to collaborate on a plan to take medications as directed while fitting this activity into the clients lifestyle.

You should suspect a ruptured kidney if a patient presents with flank pain, gross hematuria, and: A. Right shoulder pain B. Pain with inhalation. C. Pain with exhalation D. Left shoulder pain

B. Pain with inhalation.

The upper peritoneal cavity includes all of the following organs, EXCEPT the: A. Spleen B. Pancreas C. Stomach D. Gallbladder

B. Pancreas

During a client's first dialysis treatment, the client complains of a severe headache and appears somewhat confused. The priority action by the nurses is to a. administer oxygen by nasal cannula. b. encourage the client to drink fluids. c. notify the physician immediately. d. slow the rate of the dialysis.

C ~ Dialysis equilibrium syndrome can occur after dialysis, particularly during the client's first few dialysis episodes. The syndrome is characterized by mental confusion, deterioration in level of consciousness, headache, and seizures and may last for several days. The frequency or strength of the dialysate may need to be altered. The priority action by the nurse is to notify the physician; the nurse should not independently slow the dialysis rate or encourage the client to drink fluids as fluids may be restricted. Oxygen will not help the situation.

Which should the nurse recommend for the diet of a child with chronic renal failure? a. High in protein b. Low in vitamin D c. Low in phosphorus d. Supplemented with vitamins A, E, and K

C ~ Dietary phosphorus is controlled by the reduction of protein and milk intake to prevent or control the calcium-phosphorus imbalance. Protein should be limited in chronic renal failure to decrease intake of phosphorus. Vitamin D therapy is administered in chronic renal failure to increase calcium absorption. Supplementation of vitamins A, E, and K is not part of dietary management in chronic renal disease.

The nurse assesses the client for the electrolyte imbalance that tends to occur in the earlier stages of chronic renal failure, which is a. hypercalcemia. b. hypocalcemia. c. hypokalemia. d. hyponatremia.

C ~ The tubular salt-wasting properties of some failing kidneys, in addition to vomiting and diarrhea, may cause hyponatremia. Late in the disease the problem becomes hypernatremia.

In the absence of a traumatic brain injury, the goal of fluid replacement in a patient with abdominal trauma is to maintain a systolic BP of: A. 90 to 100 mmHg B. 70 to 80 mmHg C. 80 to 90 mmHg D. 100 to 110 mmHg

C. 80 to 90 mmHg

Injuries to the vascular structures in the intraperitoneal space: A. Are generally associated with flank or periumbilical bruising B. Commonly involve the inferior vena cava and phrenic artery C. Are often caused by shearing forces secondary to blunt trauma D. Are most often associated with penetrating injury mechanisms

C. Are often caused by shearing forces secondary to blunt trauma

A nurse is caring for a client following a suicide attempt. Which of the following statements by the nurse reflects a trauma-informed approach? a. "This must be difficult. Can you tell me about what has happened to you?" b. "You are new to the unit. Why are you here?" c. "You sit alone. Do you really want to be here?" d. "You seem in pain, Why did you try to harm yourself."

a. "This must be difficult. Can you tell me about what has happened to you?"