lecture last exam question frfr

A patient has VF. The nurse understands that the most effective treatment besides CPR is which of the following? A. Antiarrhythmics B. Defibrillation C. Ventilation D. Epinephrine

B

The nurse recognizes the QRS complex represents what? A. Atrial depolarization B. Ventricular depolarization C. Atrial repolarization and ventricular depolarization D. Atrial depolarization and ventricular repolarization

B

Which of the following best explains the relationship between an MCI and a disaster? A. All disasters are mass casualty events. B. All mass casualty events are disasters. C. Mass casualty events are natural disasters. D. Mass casualty events are man-made disasters.

B

Which of the following contributes the most to positive patient outcomes in a mass casualty disaster? A. On-site patient treatment B. Disaster triage C. Transport of all victims to the closest hospital D. Availability of patient air transportation

B

Disaster public warning information should include what information? 1. Instructions for evacuation 2. Shelter-in-place instructions 3. Disaster kit contents instructions 4. Calming and reassuring messages 5. Locations where to seek assistance and shelter A. All but 3 B. All but 4 C. All but 5 D. All but 2

A

Several patients present to the triage nurse in an ED. They are complaining of skin redness, itching, vomiting, and diarrhea. What does the nurse suspect the patients have been exposed to? A. Radiation B. Chemical agents C. Influenza D. Biotoxin agent

A

The ED nurse is caring for a man who was thrown against a wall following an explosion and has a ruptured spleen. What is this injury considered? A. Primary blast injury B. Secondary blast injury C. Quaternary injuries D. Penetrating ballistic injury

A

The nurse knows the heart's normal conduction system starts where? A. Sinoatrial (SA) node B. Artioventricular (AV) node C. Bundle of His D. Purkinje fibers

A

Using START, the disaster triage nurse determines which patient should have the highest triage priority (immediate - red)? A. A 70-year-old female able to follow commands, respiratory rate of 36, palpable radial pulse, open skull fracture B. A 25-year-old male covered in dust, respiratory rate of 16, walking at the scene of the disaster, fractures to both lower arms C. A 19-year-old male with a GCS of 3, unable to maintain airway after two attempts at repositioning D. A 30-year-old female, 14 weeks pregnant with a rigid abdomen, respiratory rate of 12, radial pulse of 90, able to follow commands, pale

A

Which of the following is not an appropriate intervention for all atrial dysrhythmias? A. An ECG B. A pulse check C. Blood pressure D. Cardioversion

ABC

As the nurse caring for a patient on a cardiac monitor, you understand which of the following steps are necessary to correctly identify the rhythm? (Select all that apply.) A. Determine the rate. B. Determine the regularity. C. Determine if there is a QRS for every P wave. D. Determine if there is a P wave for every QRS. E. Determine if there is a U wave for every QRS.

ABCD

Key patient teaching points for AF include which of the following? (Select all that apply.) A. Medications for HR control B. Bleeding precautions C. Signs and symptoms of AF with RVR D. Cardioversion E. Defibrillation

ABCD

Signs or symptoms of symptomatic ventricular dysrhythmias include which of the following? (Select all that apply.) A. Hypotension B. Dizziness C. Fever D. Shortness of breath E. Hypertension

ABD

While educating a patient about AF, the nurse informs the patient that which of following can be symptoms of AF? (Select all that apply.) A. Shortness of breath B. Hypotension C. Weight loss D. Dizziness E. Sweating

ABDE

The nurse understands that rhythms originating in the ventricle have which of the following characteristics? (Select all that apply.) A. Wide QRS complexes B. Narrow QRS complexes C. Only QRS complexes D. Only fast rates E. Only slow rates

AC

The nurse reviews the cardiac electrical cycle with a patient scheduled for pacemaker insertion surgery. In which order should the nurse explain this process? (Enter the number of each step in the proper sequence; do not use punctuation or spaces. Example: 1234) A. P wave B. T wave C. QRS complex D. Firing of the SA node E. Ventricular contraction F. Ventricular repolarization

ANS: D. Firing of the SA node A. P wave C. QRS complex E. Ventricular contraction B. T wave F. Ventricular repolarization Feedback: When the impulse travels along the normal conduction pathway, it generates waveforms that indicate the firing of the SA node, the P wave, followed by a QRS complex indicating ventricular contraction and a T wave indicating ventricular repolarization.

A patient is being prepared for a transvenous pacemaker. What should the nurse include when explaining this pacemaker to the family? 1) "It is inserted using an internal jugular vein." 2) "It is done by placing defibrillator pads on the torso using an anterior/posterior position." 3) "It is done by placing a pacer wire in the atrium or the ventricle and fed out through the skin, where it is attached to an external pacemaker." 4) "It is inserted by placing pacer wires in the atrium, ventricle, or both and attached to a small pacemaker generator placed under the skin near the clavicle."

ANS: 1 1) For a transvenous pacemaker a pacer wire is inserted into the right ventricle through central venous access, usually via the internal jugular vein. 2) Defibrillator pads are placed on the patient's torso using an anterior/posterior position for a transcutaneous pacemaker. 3) A pacer wire that is surgically placed in the atrium or the ventricle and fed out through the skin and attached to an external pacemaker is the process for inserting a transthoracic or epicardial pacer. 4) For all internal pacemakers, pacer wires are placed in the atrium, ventricle, or both and attached to a small pacemaker generator placed under the skin near the clavicle.

The nurse is concerned that a patient is at risk for pulseless electrical activity. What information from the assessment did the nurse use to make this clinical decision? 1) Blood pH 7.30 2) Temperature 100.5°F 3) Serum glucose level 170 mg/dL 4) Serum potassium level 4.1 mEq/L

ANS: 1 1) Causes of pulseless electrical activity include acidosis, which is reflected in a blood pH less than 7.35. 2) Causes of pulseless electrical activity include hypothermia. A temperature over 100°F would not be seen in hypothermia. 3) Causes of pulseless electrical activity include hypoglycemia. A blood glucose of 170 mg/dL would by hyperglycemia. 4) Causes of pulseless electrical activity include hyper- or hypokalemia. A serum potassium level of 4.1 mEq/L is within normal limits.

A patient is in normal sinus rhythm with prolonged PR intervals. What treatment should the nurse expect to be prescribed for this patient? 1) Continue to monitor 2) Anticipate defibrillating 3) Prepare for cardioversion 4) Prepare for pacemaker insertion

ANS: 1 1) First-degree AV block looks very similar to normal sinus rhythm except the PR interval is prolonged. Treatment is not typically required for first-degree AV block unless the patient is having symptoms, which is very rare. 2) Defibrillation is not indicated for first-degree AV block. 3) Cardioversion is not indicated for first-degree AV block. 4) A pacemaker is not indicated for first-degree AV block.

A patient with a cardiac dysrhythmia asks why it is important to recognize the signs of a stroke. What should the nurse respond to this patient? 1) "So you can respond quickly and prevent adverse effects." 2) "To encourage you to take your medication as prescribed." 3) "So that you can recognize the signs of stroke in a family member." 4) "Most people with a heart arrhythmia develop strokes as a side effect."

ANS: 1 1) It is important that the patient (and family) is able to detect early signs of complications such as a stroke to assure prompt treatment and reduce adverse effects. 2) Learning the manifestations of stroke is not to encourage the patient to take medication as prescribed. 3) Learning the manifestations of stroke is not to recognize the signs of a stroke in a family member. 4) Most people with a heart arrhythmia do not develop a stroke as a side effect.

The nurse notes that PR intervals are getting progressively longer before a QRS complex is dropped on a patient's cardiac rhythm strip. Which health problem should the nurse realize this patient is experiencing? 1) Mobitz I 2) Mobitz II 3) First-degree AV block 4) Third-degree AV block

ANS: 1 1) Second-degree AV block type I, also known as Wenckebach or Mobitz I, occurs when not all atrial impulses get through the AV node to the ventricles. There are more P waves than QRS complexes and the PR interval gets progressively longer until a QRS is dropped. 2) Second-degree AV block type II, also known as Mobitz II, drops QRS complexes, but the PR intervals are exactly the same length with each complex. 3) First-degree AV block looks similar to a normal sinus rhythm except the PR interval is prolonged. 4) In third-degree AV block or complete heart block the AV node is completely blocked and prevents any impulses from entering or exiting. There is no communication between the atria and the ventricles. The ECG records more P waves than QRS complexes.

During a home visit the nurse learns that a patient has been skipping doses of antiarrhythmic medication. What should the nurse include when counseling this patient? 1) Taking the medication as prescribed reduces the occurrence of side effects 2) Skipping doses increases the risk of developing chest pain and diaphoresis. 3) Adequate medication level decreases the adverse effects of the dysrhythmia. 4) Insufficient amounts of medication in the blood stream affect pacemaker functioning.

ANS: 1 1) There is evidence to support that taking antiarrhythmic medication as prescribed will reduce the occurrence of side effects. 2) There is no evidence to support that skipping antiarrhythmic medication doses increases the risk of developing chest pain and diaphoresis. 3) Maintaining adequate medication levels helps decrease the occurrence of adverse effects of dysrhythmias. 4) There is no evidence to support that skipping antiarrhythmic medication will adversely affect pacemaker functioning.

A patient is diagnosed with third-degree AV block. For which type of pacemaker should the nurse prepare this patient? 1) Transvenous 2) Biventricular 3) Transthoracic 4) Transcutaneous

ANS: 1 1) Transcutaneous pacing is indicated in patients with symptomatic complete heart block. 2) A biventricular pacemaker is not indicated for third-degree AV block. 3) A transthoracic pacemaker is not indicated for third-degree AV block. 4) Transcutaneous pacing is used primarily for second-degree AV block.

A patient with shortness of breath has a heart rhythm of 46 beats per minute. Which medication should the nurse anticipate being prescribed for this patient? 1) Atropine sulfate 2) Atenolol (Tenormin) 3) Diltiazem (Cardizem) 4) Adenosine (Adenocard)

ANS: 1 1) Treatment of symptomatic sinus bradycardia is atropine 0.5 mg IV push. 2) Atenolol (Tenormin) is used in the treatment of sinus tachycardia. 3) Diltiazem (Cardizem) is used in the treatment of atrial fibrillation or atrial flutter. 4) Adenosine (Adenocard) is used in the treatment of supraventricular tachycardia.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The nurse is caring for a patient with a potentially life-threatening cardiac dysrhythmia. What should be included in this patient's plan of care? Select all that apply. 1) Document frequency of dysrhythmia 2) Administer antiarrhythmic medications 3) Maintain continuous cardiac monitoring 4) Prepare to administer advanced cardiac life support 5) Complete preoperative checklist for pacemaker insertion

ANS: 1, 2, 3, 4 1) For the patient with a potentially life-threatening dysrhythmia the nurse should document the frequency of the dysrhythmia, 2) For the patient with a potentially life-threatening dysrhythmia the nurse should administer antiarrhythmic medication. 3) For the patient with a potentially life-threatening dysrhythmia the nurse should maintain continuous cardiac monitoring. 4) For the patient with a potentially life-threatening dysrhythmia the nurse should prepare to administer advanced cardiac life support. 5) Not all patients with potentially life-threatening dysrhythmias will have a pacemaker inserted.

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

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

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

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

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

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

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

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

An older client is being evaluated for a new onset of a cardiac dysrhythmia. What should the nurse consider as being the cause for this abnormal heart rhythm? Select all that apply. 1) Advanced age 2) Protein malnutrition 3) Fat deposits around the SA node 4) Fewer pacemaker cells in the SA node 5) Calcification around the SA node and valves

ANS: 1, 3, 4, 5 1) Age is a primary risk factor for the development of dysrhythmias. 2) Protein malnutrition is not identified as being a risk factor for the development of dysrhythmias. 3) Older adults may have fat deposits around the SA node causing a delay in the propagation of the action potential. 4) Older adults have fewer pacemaker cells in the SA node causing a delay in the propagation of the action potential. 5) Slowed impulse transmission may be related to calcification around the AV node and valves.

A patient is experiencing supraventricular tachycardia. What should be done before determining this patient's treatment? 1) Assess for thyroid disease 2) Identify the underlying rhythm 3) Evaluate serum electrolyte values 4) Study lifestyle and behavioral habits

ANS: 2 1) Thyroid disease is not associated with supraventricular tachycardia. 2) The key for treating supraventricular tachycardia is to figure out the underlying rhythm while slowing down the heart rate. 3) Serum electrolyte levels are not usually associated with supraventricular tachycardia. 4) Lifestyle and behavioral habits are not usually associated with supraventricular tachycardia.

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

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

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

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

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

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

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

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

A patient becomes unresponsive without a palpable pulse despite showing bradycardia on the rhythm strip. What action should the nurse take immediately? Select all that apply. 1) Auscultate heart sounds 2) Begin cardiac compressions 3) Adjust cardiac monitor leads 4) Prepare for chest tube insertion 5) Place epinephrine at the bedside

ANS: 2, 5 1) Auscultating for heart sounds will waste time when pulseless electrical activity occurs. 2) If pulseless electrical activity occurs, the nurse should begin chest compressions. 3) Adjusting cardiac monitor leads will waste time when pulseless electrical activity occurs. 4) Although a pneumothorax can cause pulseless electrical activity, a chest tube is not the treatment for all episodes of this disorder. 5) The treatment for pulseless electrical activity includes epinephrine.

A patient has a heart rate of 132 beats per minute. What should the nurse assess to help determine the reason for this rate? Select all that apply. 1) Muscle tone 2) Temperature 3) Urine output 4) Bowel sounds 5) Blood pressure

ANS: 2, 5 1) Muscle tone is not used to determine the cause for sinus tachycardia. 2) Causes of sinus tachycardia include fever. 3) Urine output is not used to determine the cause for sinus tachycardia. 4) Bowel sounds are not used to determine the cause for sinus tachycardia. 5) Causes of sinus tachycardia include hypotension.

A patient asks why cardiac leads are being placed on the chest. What should the nurse respond to this patient? 1) "It shows where the heart vessels are blocked." 2) "It is used to evaluate the effectiveness of dietary changes." 3) "It provides a graphic picture of the heart's electrical activity." 4) "It determines which medications are needed to improve heart function."

ANS: 3 1) An electrocardiogram does not necessarily show where the heart vessels are blocked. 2) An electrocardiogram is not used to evaluate the effectiveness of dietary changes. 3) An electrocardiogram provides a graphic representation of the heart's electrical activity. 4) An electrocardiogram is not used to determine medications to improve heart function.

The nurse is observed marching out the rhythm on a patient's cardiac monitor tracing. What is this nurse assessing? 1) Rate 2) Polarity 3) Regularity 4) Amplitude

ANS: 3 1) Counting the number of small or large boxes on the tracing paper is used to calculate rate. 2) The direction of the tracing from the baseline is used to determine polarity. 3) Regularity can be determined by counting the boxes between the waveforms being measured A regular rhythm will have the same number of boxes or equal space between waveforms or complexes. This is called marching out the rhythm. 4) The height of the tracing is used to determine amplitude.

A patient with atrial fibrillation has a heart rate of 90 beats per minute. Which manifestation should the nurse expect to assess in this patient? 1) Headache 2) Chest pain 3) Palpitations 4) Hypotension

ANS: 3 1) Headache is not associated with atrial fibrillation. 2) Chest pain is not associated with atrial fibrillation. 3) Palpitations are associated with atrial fibrillation. 4) Hypotension is not associated with atrial fibrillation.

A patient with a cardiac dysrhythmia is experiencing nausea and vomiting. What is the reason for this to occur? 1) Poor contractile function 2) Altered electrolyte levels 3) Blood shunted away from nonessential organ systems 4) An imbalance in myocardial oxygen supply and demand

ANS: 3 1) Poor contractile function causes peripheral edema. 2) Altered electrolyte levels can indicate acute cardiac injury. 3) Shunting of blood away from nonessential organ systems during low-flow states may cause nausea and vomiting. 4) An imbalance in myocardial oxygen supply and demand causes chest pain.

A patient is admitted for treatment for a low junctional rhythm. Where should the nurse expect to assess the P wave on this patient's electrocardiogram? 1) Prior to the QRS wave 2) Buried within the QRS wave 3) At the tail end of the QRS wave 4) Superimposed over the previous T wave

ANS: 3 1) Retrograde P wave prior to the QRS wave is also known as a high junctional. 2) Retrograde P wave buried within the QRS wave is also known as a mid-junctional. 3) Retrograde P wave at the tail end of the QRS wave is also known as low junctional. 4) Retrograde P waves are not superimposed over the previous T wave.

A patient's heart rate is 48 beats per minute. Which structure is most likely generating this heart rate? 1) Purkinje fibers 2) Sinoatrial node 3) Atrioventricular node 4) Ventricular pacer cells

ANS: 3 1) The Purkinje fibers can generate a ventricular rate of 20 beats per minute (bpm) or less. 2) The sinoatrial (SA) node can generate impulses at a rate of 60 to 100 bpm. 3) The AV node can generate impulses at a rate of 40 to 60 bpm. 4) The ventricular pacer cells can generate impulses at a rate of 40 bpm or less.

A patient is being cardioverted for symptomatic atrial fibrillation. At which point of the cardiac cycle will the electric impulse occur? 1) At the end of the P wave 2) Before the QRS complex 3) At the peak of the R wave 4) After the QRS complex but before the T wave

ANS: 3 1) Cardioversion is not done at the end of the P wave. 2) Cardioversion is not done before the QRS complex. 3) Cardioversion is the controlled electrical discharge of energy at the peak of the R wave. 4) Cardioversion is not done after the QRS complex or before the T wave.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A patient with atrial fibrillation is being considered for cardioversion. Which diagnostic test should the nurse anticipate being prescribed prior to this procedure being completed? 1) Chest x-ray 2) CT scan of the chest 3) 12-lead electrocardiogram 4) Transesophageal echocardiogram (TEE)

ANS: 4 1) A chest x-ray most likely will be done; however, this does not need to be completed prior to cardioversion. 2) A CT scan of the chest does not need to be done prior to cardioversion. 3) A 12-lead electrocardiogram most likely will be done; however, this does not need to be completed prior to cardioversion. 4) Cardioversion should be considered for atrial fibrillation only after the atrium has been evaluated for the presence of clots by transesophageal echocardiogram (TEE).

The nurse notes that a patient with a cardiac dysrhythmia is developing shortness of breath. What is the pathophysiological reason for this manifestation? 1) Decreased oxygen in the brain 2) Stimulation of the sympathetic nervous system 3) Imbalance in myocardial oxygen demand and supply 4) Increase in oxygenation because of a drop in cardiac output

ANS: 4 1) Decreased oxygen in the brain alters the level of consciousness. 2) Stimulation of the sympathetic nervous system causes diaphoresis. 3) Imbalanced myocardial oxygen demand and supply causes chest pain. 4) Because of the lack of efficient contractile function of a heart experiencing dysrhythmias, cardiac output may fall, causing a decrease in blood pressure. In an attempt to increase oxygenation in the face of decreased cardiac output, shortness of breath and tachypnea may occur.

When analyzing a patient's electrocardiogram, the nurse notes that the P wave is normal. What criteria did the nurse use to make this decision? 1) Pointed and skinny in width 2) Small and rounded in lead II 3) Upright and rounded in lead II 4) Length 0.10 seconds and height 2.5 mm

ANS: 4 1) The QRS complex is pointed and skinny in width. 2) The U wave is small and rounded in lead II 3) The T wave is upright and rounded in lead II. 4) The P wave itself should not be longer than 0.10 sec in length and no higher than 2.5 mm.

A patient is being evaluated for a blockage in the cardiac ventricles. On which part of the electrocardiogram should the nurse focus as evidence of this blockage? 1) T wave 2) U wave 3) PR interval 4) QRS interval

ANS: 4 1) The T wave occurs after the QRS and represents ventricular repolarization. 2) The U wave represents Purkinje fiber repolarization and is rarely seen. 3) The PR interval is the measure of time that it takes an electrical impulse to depolarize the atria and travel to the ventricles. 4) The QRS interval is the measure of time to depolarize the ventricles. The normal interval is 0.04 to 0.10 sec in length. If the QRS is prolonged it may be a sign of a disturbance within the ventricle itself such as a block in the ventricles delaying impulse travel time through the ventricles.

The nurse is preparing to defibrillate a patient. Which setting should the nurse use for this treatment? 1) 50 J 2) 100 J 3) 150 J 4) 200 J

ANS: 4 1) The energy level for cardioversion begins at 50 J. 2) The energy level for cardioversion can be increased to 100 J. 3) The energy level for cardioversion can be increased to 200 J. 4) The energy level for defibrillation is 200 J.

A patient's cardiac rhythm has no identifiable P or QRS waves. What action should the nurse take first? 1) Apply oxygen 2) Assess a radial pulse 3) Insert an intravenous line 4) Begin chest compressions

ANS: 4 1) The nurse would be wasting time applying oxygen. 2) Assessing a radial pulse would be wasting time. 3) Inserting an intravenous line would be wasting time. 4) In ventricular fibrillation there are no identifiable P or QRS waves. Chest compressions should be initiated immediately and maintained as continuously as possible.

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

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

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

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

An early sign of hypoxemia is A. Clubbing of the fingernails B. Cyanosis C. Somnolence D. Restlessness and anxiety

Answer: D Rationale: The patient experiencing hypoxemia will show restlessness and anxiety first due to decreased oxygen flow to the brain. Cyanosis occurs later. Clubbing is a sign of long term hypoxemia. Somnolence may indicate increased PaCO2

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

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

When calculating a patient's heart rate using the cardiac rhythm strip, the nurse notes the presence of four large boxes between the two R waves. What is this patient's heart rate? Record your answer as a whole number. ______

ANS: 75 Feedback: One method to calculate HR is to count the number of large boxes between two R waves and divide that number into 300. If four large boxes are present, then 300/4 = 75.

The pulmonary edema associated with ARDS is caused by: A. Increased permeability of the ACM B. Right ventricular failure with pulmonary hypertension C. Left ventricular failure due to poor oxygenation D. Fluid overload related to resuscitation in the first phase

Answer: A Rationale: The pulmonary edema is non-cardiogenic, caused by the leak of plasma out of the vascular space and into the alveoli and interstitial spaces of the lungs.

The nurse understands the priority action for a patient with a chest tube that has come disconnected from the chest drainage system is which of the following? A. Immediately cover the end of the chest tube with a sterile dressing. B. Immediately submerge the end of the chest tube in sterile water. C. Immediately reconnect the end of the chest tube with the drainage system. D. Immediately page the provider to insert a new chest tube.

Answer: B Rationale: If a chest tube becomes disconnected from the drainage system, it is imperative to submerge the end in sterile water to provide a water seal until a new drainage system is connected.

Air enters the lungs due to A. Negative intrathoracic pressure (pressure lower than atmospheric pressure) and contraction of the diaphragm (inspiration) B. Positive intrathoracic pressure and relaxation of the diaphragm (exhalation) C. Chemoreceptors which are sensitive to the level of carbon dioxide in the blood which will stimulate the brain to control the respiratory rate D. A sympathetic nervous system response to stress which will increase the respiratory rate

Answer: A

Oxygen passes from the alveoli to the blood stream via: A. Diffusion—oxygen moves from an area of higher pressure to an area of lower pressure B. Ventilation—air moves into and out of the lungs which brings oxygen to the alveoli for exchange C. Perfusion—oxygen is carried away from the alveoli by capillaries through the pumping action of the heart

Answer: A

The primary functions of the respiratory system are: A. Provision of oxygen and removal of carbon dioxide B. Provision of oxygen and maintenance of acid-base balance C. Removal of oxygen and provision of carbon dioxide D. Maintenance of acid-base balance and body water levels

Answer: A

The nurse caring for a patient with a closed pneumothorax will monitor closely for which of these complications? A. Tension pneumothorax B. Flail chest C. Cardiac tamponade D. Pulmonary embolus

Answer: A Rationale: The patient who has experienced a pneumothorax is at risk for tension pneumothorax if there is a continued accumulation of air into the pleural space

The nurse understands oxygen therapy for a patient with COPD requires close monitoring because of which of the following? A. Hypoxic respiratory drive B. Hypercapnic respiratory drive C. Acidotic respiratory drive D. Alkalotic respiratory drive

Answer: A Rationale: The patient with COPD has a hypoxic drive to breathe so requires close observation while receiving oxygen.

In assessing a patient's arterial blood gases, who is diagnosed with early stage acute respiratory failure, the nurse would expect to see which of the following results? A. pH 7.38, PaCO2 48mm Hg, HCO3 24mm Hg, PaO2 88mm Hg, SaO2 96% B. pH 7.48, PaCO2 30mm Hg, HCO3 26mm Hg, PaO2 52mm Hg, SaO2 90% C. pH 7.48, PaCO2 44mm Hg, HCO3 30mm Hg, PaO2 70mm Hg, SaO2 94% D. pH 7.34, PaCO2 40mm Hg, HCO3 18mm Hg, PaO2 74mm Hg, SaO2 98%

Answer: B Rationale: In the early stages of acute respiratory failure the nurse would anticipate that the client's respiratory rate is elevated and oxygenation would be decreased resulting in a respiratory alkalosis with hypoxemia.

After oxygen has been administered, the next nursing intervention for a patient with a pulmonary embolus is the administration of which of these therapies? A. Normal saline IV fluid B. IV heparin C. Platelet administration D. Antibiotics for inflammatory fever

Answer: B Rationale: Once the diagnosis of pulmonary embolism has been made, anticoagulation with intravenous heparin therapy would be started as soon as possible. IVFs may be indicated but not the priority. Antibiotics and platelets are not indicated.

A patient with a diagnosis of pneumonia complains of new onset of slight shortness of breath. Which of the following assessment findings will the nurse call the provider with immediately? A. The patient is voiding, but the amounts are decreasing. B. There is a pink coloration to the skin. C. The patient's secretions are thin and milky colored. D. The patient thought it was the third instead of the fifth of the month.

Answer: B Rationale: Pink coloration to the skin indicates that the patient's PaCO2 is rising, and this may indicate deterioration of the patient's respiratory status.

The nurse understands tracheal deviation in a newly admitted patient to the emergency department is typically caused by which of the following? A. Hemothorax B. Tension pneumothorax C. Flail chest D. Subcutaneous emphysema

Answer: B Rationale: Tracheal deviation is a classic manifestation of tension pneumothorax.

A patient who is tachypneic for an extended period of time will demonstrate which of the following arterial blood gas results? A. Respiratory alkalosis with hypercapnia B. Respiratory acidosis will a rising pH C. Respiratory alkalosis with hypocapnia D. No changes in the results due to metabolic compensation

Answer: C Rationale: A patient who is tachypneic for an extended period of time, will blow off quite a bit of CO2 with a resultant respiratory alkalosis.

A nurse is scheduled to take care of these four patients in a trauma step-down unit. Which one should the nurse assess first based on this information from report? A. A 19-year-old, 2 days post motor vehicle crash, rib fractures and on CPAP for oxygenation issues, complaining of increasing chest pain B. A 40-year-old, 1 day post-operative for a ruptured spleen following a motor vehicle accident, slightly confused about how he got to the unit C. A 21-year-old, still comatose following a fall and flail chest remains stable on a ventilator and drug therapy for low blood pressure D. A 60-year-old with a left femur fracture following a farming accident who is experiencing new onset of slight shortness of breath

Answer: C Rationale: Patient in C will require a quick look to assess continued stability due to the artificial airway and vasoactive drug therapy before quickly assessing patient in D who could be experiencing a pulmonary embolism.

The nurse anticipates which of the following in the initial care of a patient with ARDS? A. Inotropic agents B. IV fluids C. Anticoagulants D. Positive-pressure ventilation

Answer: D Rationale: The first step in caring for any patient with ARDS is to treat the refractory hypoxemia with positive pressure ventilation.

Your patient requires immediate cardioversion, which is defined as which of the following? A. A controlled electrical shock that is triggered by and fires on the P wave B. A controlled electrical shock that is triggered by and fires on the R wave C. A controlled electrical shock that is triggered by and fires on the T wave D. An electrical shock that fires randomly during the cardiac cycle

B

As the nurse, you know that the following can cause rhythm disorders: (Select all that apply.) A. Exercise B. Electrolyte imbalances C. Myocardial hypertrophy D. Myocardial damage E. Eating red meat

BCD

The nurse recognizes the artioventricular (AV) node generates electrical impulses at a rate of: A. ≤ 20 bpm B. ≤ 40 bpm C. 40-60 bpm D. 60-100 bpm

C

The nurse understands that the normal conduction pathway for the heart is which of the following? A. AV → SA → Ventricles → Purkinje fibers B. Purkinje fibers → AV → Ventricles → SA C. SA → AV → Ventricles → Purkinje fibers D. Ventricles → Purkinje fibers → SA → AV

C

Which of the following contributes to a successful hospital disaster response? A. Aggressive resuscitation efforts for patients without a pulse B. Immediate response for patients as soon as they arrive at the ED C. Appropriate PPE to protect staff from contamination D. Decontamination area located within the ED

C

The nurse understands transcutaneous pacing is necessary for which symptomatic patient? A. Sinus tachycardia B. Sinus rhythm with PACs C. Atrial fibrillation D. Complete heart block

D

Which of the following dysrhythmias requires defibrillation? A. Atrial tachycardia B. Atrial fibrillation C. Ventricular tachycardia with a pulse D. Ventricular fibrillation

D

Which of the following is an example of a natural disaster? A. The 1984 Bhopal, India, methyl isocyanate release B. The March 20, 1995, sarin incident in Japan C. The 2007 Virginia Tech campus shootings D. The 2011 earthquake in Japan

D

Which of the following minimizes health-care worker stress during and/or after a disaster? A. Assurances that he or she will be paid overtime B. A debriefing at the start of the event C. Eliminating the ICS D. Having a personal disaster plan

D

10. What is considered a subjective confirmatory tests to establish brain death? a. Apnea test b. Cerebral angiography c. Intracranial blood flow d. CTA (CT angiogram)

a. Apnea test

6. What conditions are absolute contraindications to organ donations? SELECT ALL THAT APPLY: a. Certain active parasitic infections b. Creutzfeldt-Jacobs disease c. HIV d. Meningitis e. Tuberculosis

a. Certain active parasitic infections b. Creutzfeldt-Jacobs disease d. Meningitis e. Tuberculosis

2. To establish brain death, which brain stem reflexes are assessed? SELECT ALL THAT APPLY: a. Corneal reflexes. b. Deep-tendon reflexes. c. Lazarus reflex. d. Pharyngeal (gag) reflex. e. Pupillary reflexes.

a. Corneal reflexes. d. Pharyngeal (gag) reflex. e. Pupillary reflexes.

5. Which situations trigger a call to the organ procurement coordinator by the nurse? SELECT ALL THAT APPLY: a. GCS (Glasgow Coma Scale) less than or equal to 5. b. Patients with a grave prognosis. c. Absence of 2 or more brain stem reflexes. d. Family is considering withdrawal of treatment and initiation of comfort measures. e. All patients with head injuries.

a. GCS (Glasgow Coma Scale) less than or equal to 5. b. Patients with a grave prognosis. c. Absence of 2 or more brain stem reflexes.

4. The New Jersey Hero Act was passed in 2008 to accomplish which outcomes? SELECT ALL THAT APPLY: a. Increase the supply of donor organs through providing facts about organ donation. b. Require nursing students to complete education on organ donation as a degree requirement. c. Prevent drunk driving. d. Require physicians to complete education on organ donation as a degree requirement. e. Provide accurate information regarding organ donation.

a. Increase the supply of donor organs through providing facts about organ donation. b. Require nursing students to complete education on organ donation as a degree requirement. d. Require physicians to complete education on organ donation as a degree requirement. e. Provide accurate information regarding organ donation.

What statement is correct regarding donation after cardiac death? a. The patient can only donate if they expire within a certain time after extubation. b. The patient does not have any brain stem reflexes. c. The patient must undergo objective confirmative tests. d. The patient can only donate tissues.

a. The patient can only donate if they expire within a certain time after extubation.

9. What is considered an objective confirmatory tests to establish brain death? a. Apnea test. b. Cerebral angiography. c. Oculocephalic (dolls eyes) test. d. Pharyngeal test.

b. Cerebral angiography.

8. What is the protocol for donation after cardiac death if patients do not expire after extubation within 90 minutes? a. The patient will be reintubated and returned to the intensive care unit. b. The patient will be brought to a room for initiation of comfort measures and the family will be advised. c. The patient will remain in the operating room suite until they cease to breathe. d. The patient will have all life-saving measures re-initiated.

b. The patient will be brought to a room for initiation of comfort measures and the family will be advised.

3. What is not a consideration when deciding allocation of donated organs? a. Donor blood type. b. Geographical location of recipient. c. Race of recipient. d. Blood type of recipient.

c. Race of recipient.

7. Which of statements is correct regarding barriers to organ donation? a. Most major religions do not approve of organ donation. b. The organ donation process damages body integrity and does not allow for an open casket wake. c. Organ donation is too costly for most patients. d. Individuals have difficulty understanding brain death determination.

d. Individuals have difficulty understanding brain death determination.