Chapter 69 Nursing Management Emergency, Terrorism, and Disaster Nursing

1. During the primary assessment of a victim of a motor vehicle collision, the nurse determines
that the patient is breathing and has an unobstructed airway. Which action should the nurse
take next?
A) Palpate extremities for bilateral pulses.
B) Observe the patient's respiratory effort.
C) Check the patient's level of consciousness.
D) Examine the patient for any external bleeding.
ANS: B) Even with a patent airway, patients can have other problems that
compromise ventilation, so the next action is to assess the patient's breathing.
The other actions are also part of the initial survey but assessment of breathing
should be done immediately after assessing for airway patency.
2. During the primary survey of a patient with severe leg trauma, the nurse observes that the
patient's left pedal pulse is absent and the leg is swollen. Which action will the nurse take
next?
A) Send blood to the lab for a complete blood count.
B) Assess further for a cause of the decreased circulation.
C) Finish the airway, breathing, circulation, disability survey.
D) Start normal saline fluid infusion with a large-bore IV line.
ANS: D) The assessment data indicate that the patient may have arterial trauma
and hemorrhage. When a possibly life-threatening injury is found during the
primary survey, the nurse should immediately start interventions before
proceeding with the survey. Although a complete blood count is indicated,
administration of IV fluids should be started first. Completion of the primary
survey and further assessment should be completed after the IV fluids are
initiated.
3. After the return of spontaneous circulation following the resuscitation of a patient who had a
cardiac arrest, therapeutic hypothermia is ordered. Which action will the nurse include in
the plan of care?
A) Apply external cooling device.
B) Check mental status every 15 minutes.
C) Avoid the use of sedative medications.
D) Rewarm if temperature is <91 F (32.8 C).
ANS: A) When therapeutic hypothermia is used postresuscitation, external cooling
devices or cold normal saline infusions are used to rapidly lower body
temperature to 89.6 F to 93.2 F (32 C to 34 C). Because hypothermia will
decrease brain activity, assessing mental status every 15 minutes is not needed
at this stage. Sedative medications are administered during therapeutic
hypothermia.
4. A patient who is unconscious after a fall from a ladder is transported to the emergency
department by emergency medical personnel. During the primary survey of the patient, the
nurse should
A) a. assess the patient's vital signs.
B) b. attach a cardiac electrocardiogram (ECG) monitor.
C) c. obtain a Glasgow Coma Scale score.
D) d. ask about chronic medical conditions.
ANS: C) The Glasgow Coma Scale is included when assessing for disability
during the primary survey. The other information is part of the secondary
survey.

5. An 18-year-old is brought to the emergency department (ED) with multiple lacerations and
tissue avulsion of the right hand. When asked about tetanus immunization, the patient
denies having any previous vaccinations. The nurse will anticipate administration of
A) a. tetanus-diphtheria toxoid (Td) only.
B) b. tetanus immunoglobulin (TIG) only.
C) c. TIG and tetanus-diphtheria toxoid (Td).
D) d. TIG and tetanus-diphtheria toxoid and pertussis vaccine (Tdap).
ANS: D) For an adult with no previous tetanus immunizations, TIG and Tdap are
recommended. The other immunizations are not sufficient for this patient.
6. A patient who has experienced blunt abdominal trauma during a car accident is complaining
of increasing abdominal pain. The nurse will plan to teach the patient about the purpose of
A) a. ultrasonography.
B) b. peritoneal lavage.
C) c. nasogastric (NG) tube placement.
D) d. magnetic resonance imaging (MRI).
ANS: A) For patients who are at risk for intraabdominal bleeding, focused
abdominal ultrasonography is the preferred method to assess for intraperitoneal
bleeding. An MRI would not be used. Peritoneal lavage is an alternative, but it
is more invasive. An NG tube would not be helpful in diagnosis of
intraabdominal bleeding.
7. A patient with hypotension and temperature elevation after doing yard work on a hot day is
treated in the ED. After the nurse has completed discharge teaching, which statement by
the patient indicates that the teaching has been effective?
A) a. "I will take salt tablets when I work outdoors in the summer."
B) b. "I should take acetaminophen (Tylenol) if I start to feel too warm."
C) c. "I should have sports drinks when exercising outside in hot weather."
D) d. "I will get into a cool environment if I notice that I am feeling confused."
ANS: C) Electrolyte solutions such as sports drinks help replace fluid and
electrolytes lost when exercising in hot weather. Salt tablets are not
recommended because of the risks of gastric irritation and hypernatremia.
Antipyretic medications are not effective in lowering body temperature
elevations caused by excessive exposure to heat. A patient who is confused is
likely to have more severe hyperthermia and will be unable to remember to
take appropriate action.
8. When preparing to rewarm a patient with hypothermia, the nurse will plan to
A) a. attach a cardiac monitor.
B) b. insert a urinary catheter.
C) c. assist with endotracheal intubation.
D) d. have sympathomimetic drugs available.
ANS: A) Rewarming can produce dysrhythmias, so the patient should be
monitored and treated if necessary. Urinary catheterization and endotracheal
intubation are not needed for rewarming. Sympathomimetic drugs tend to
stimulate the heart and increase the risk for fatal dysrhythmias such as
ventricular fibrillation.

9. A patient who experienced a near drowning accident in a local lake, but now is awake and
breathing spontaneously, is admitted for observation. Which action will be most important
for the nurse to take during the observation period?
A) a. Listen to heart sounds.
B) b. Palpate peripheral pulses.
C) c. Auscultate breath sounds.
D) d. Check pupil reaction to light.
ANS: C) Since pulmonary edema is a common complication after near drowning,
the nurse should assess the breath sounds frequently. The other information
also will be collected by the nurse, but it is not as pertinent to the patient's
admission diagnosis.
10. When planning the response to the potential use of smallpox as an agent of terrorism, the
emergency department (ED) nurse-manager will plan to obtain sufficient quantities of
A) a. blood.
B) b. vaccine.
C) c. atropine.
D) d. antibiotics.
ANS: B) Smallpox infection can be prevented or ameliorated by the administration
of vaccine given rapidly after exposure. The other interventions would be
helpful for other agents of terrorism but not for smallpox.
11. When rewarming a patient who arrived in the emergency department (ED) with a
temperature of 87 F, which assessment indicates that the nurse should discontinue the
rewarming?
A) a. The patient stops shivering.
B) b. The BP decreases to 85/40 mm Hg.
C) c. The patient develops atrial fibrillation.
D) d. The core temperature is 94 F (34.4 C).
ANS: D) A core temperature of 89.6 F to 93.2 F (32 C to 34 C) indicates that
sufficient rewarming has occurred. Dysrhythmias, hypotension, and shivering
may occur during rewarming and should be treated but are not an indication to
stop rewarming the patient.
12. When assessing a patient admitted to the emergency department (ED) with a broken arm and
facial bruises, the nurse notes multiple additional bruises in various stages of healing.
Which statement or question by the nurse is most appropriate?
A) a. "Is someone at home hurting you?"
B) b. "You should not return to your home."
C) c. "Would you like to see a social worker?"
D) d. "I have to report this abuse to the police."
ANS: A) The nurse's initial response should be to further assess the patient's
situation. Telling the patient not to return home may be an option once further
assessment is done. The patient, not the nurse, is responsible for reporting the
abuse. A social worker may be appropriate once further assessment is
completed.

13. A patient arrives in the emergency department (ED) a few hours after taking "20 to 30"
acetaminophen (Tylenol) tablets. Which action will the nurse plan to take?
A) a. Give N-acetylcysteine (Mucomyst).
B) b. Discuss the use of chelation therapy.
C) c. Have the patient drink large amounts of water.
D) d. Administer oxygen using a non-rebreather mask.
ANS: A) N-acetylcysteine is the recommended treatment to prevent liver damage
after acetaminophen overdose. The other actions might be used for other types
of poisoning, but they will not be appropriate for a patient with acetaminophen
poisoning.
14. A triage nurse in a busy emergency department assesses a patient who complains of 6/10
abdominal pain and states, "I had a temperature of 104.6 F (40.3 C) at home." The
nurse's first action should be to
A) a. assess the patient's current vital signs.
B) b. obtain a clean-catch urine for urinalysis.
C) c. tell the patient that it may be several hours before being seen by the doctor.
D) d. ask the health care provider to order an analgesic medication for the patient.
ANS: A) The patient's pain and statement about an elevated temperature indicate
that the nurse should obtain vital signs before deciding how rapidly the patient
should be seen by the health care provider. A urinalysis may be needed, but
vital signs will provide the nurse with the data needed to determine this. The
health care provider will not order a medication before assessing the patient.
15. The emergency department (ED) triage nurse is assessing four victims of an automobile
accident. Which patient has the highest priority for treatment?
A) a. A patient with absent pedal pulses
B) b. A patient with an open femur fracture
C) c. A patient with a sucking chest wound
D) d. A patient with bleeding of facial lacerations
ANS: C) Most immediate deaths from trauma occur because of problems with
ventilation, so the patient with a sucking chest wound should be treated first.
Face and head fractures can obstruct the airway, but the patient with facial
injuries has lacerations only. The other two patients also need rapid
intervention but do not have airway or breathing problems.
16. The following actions are part of the routine emergency department (ED) protocol for a
patient who has been admitted with multiple bee stings to the hands. Which action should
the nurse take first?
A) a. Remove the patient's rings.
B) b. Place ice packs on both hands.
C) c. Apply calamine lotion to any itching areas.
D) d. Give diphenhydramine (Benadryl) 100 mg PO.
ANS: A) The patient's rings should be removed first because it might not be
possible to remove them if swelling develops. The other orders also should be
implemented as rapidly as possible after the nurse has removed the jewelry.

17. Gastric lavage and administration of activated charcoal are prescribed for an unconscious
patient who has been admitted to the emergency department (ED) after ingesting 30
diazepam (Valium) tablets. Which action will the nurse plan to take first?
A) a. Administer activated charcoal.
B) b. Insert a large-bore orogastric tube.
C) c. Prepare a 60-mL syringe with saline.
D) d. Assist with intubation of the patient.
ANS: D) In an unresponsive patient, intubation is done before gastric lavage and
activated charcoal administration to prevent aspiration. The other actions will
be implemented after intubation.
18. A patient arrives in the emergency department after exposure to radioactive dust. Which
action should the nurse take first?
A) a. Place the patient in a shower.
B) b. Obtain the patient's vital signs.
C) c. Determine the type of radioactive agent.
D) d. Obtain a baseline complete blood count.
ANS: A) The initial action should be to protect staff members and decrease the
patient's exposure to the radioactive agent by decontamination. The other
actions can be done after the decontamination is completed.
19. An unresponsive 78-year-old is admitted to the emergency department (ED) during a
summer heat wave. The patient's core temperature is 106.2 F (41.2 C), blood pressure
(BP) 86/52, and pulse 102. The nurse initially will plan to
A) a. administer an aspirin rectal suppository.
B) b. start O2 at 6 L/min with a nasal cannula.
C) c. apply wet sheets and a fan to the patient.
D) d. infuse lactated Ringer's solution at 1000 mL/hr.
ANS: C) The priority intervention is to cool the patient. Antipyretics are not
effective in decreasing temperature in heat stroke, and 100% oxygen should be
given, which requires a high flow rate through a non-rebreather mask. An older
patient would be at risk for developing complications such as pulmonary
edema if given fluids at 1000 mL/hr.
20. When a patient is admitted to the emergency department after a submersion injury, which
assessment will the nurse obtain first?
A) a. Apical pulse
B) b. Lung sounds
C) c. Body temperature
D) d. Level of consciousness
ANS: B) The priority assessment data are how well the patient is oxygenating, so
lung sounds should be assessed first. The other data also will be collected
rapidly but are not as essential as the lung sounds.
21. Following an earthquake, patients are triaged by emergency medical personnel and are
transported to the hospital. Which of these patients will the nurse need to assess first?
A) a. A patient with a red tag
B) b. A patient with a blue tag
C) c. A patient with a yellow tag
D) d. A patient with a green tag
ANS: A) The red tag indicates a patient with a life-threatening injury requiring
rapid treatment. The other tags indicate patients with less urgent injuries or
those who are likely to die.

22. A patient's family members are in the patient room when the patient has a cardiac arrest and
emergency personnel start resuscitation measures. Which action is best for the nurse to
take initially?
A) a. Have the family wait outside the patient room with a designated staff member to
provide emotional support.
B) b. Keep the family in the room and assign a member of the team to explain the care
given and answer questions.
C) c. Ask the family members about whether they would prefer to remain in the patient
room or wait outside the room.
D) d. Advise the family members that patients are comforted by having family members
present during resuscitation efforts.
ANS: C) Although many family members and patients report benefits from family
presence during resuscitation efforts, the nurse's initial action should be to
determine the preference of these family members. The other actions may be
appropriate, but this will depend on what is learned when assessing family
preferences.
23. These four patients arrive in the emergency department after a motor vehicle crash. In which
order should they be assessed? (SELECT ALL THAT APPLY.)
A) a. A 72-year-old with palpitations and chest pain
B) b. A 45-year-old complaining of 6/10 abdominal pain
C) c. A 22-year-old with multiple fractures of the face and jaw
D) d. A 30-year-old with a misaligned right leg with intact pulses

ANS: C, A, B, D) The highest priority is to assess the 22-year-old patient for

airway obstruction, which is the most life-threatening injury. The 72-year-old
patient may have chest pain from cardiac ischemia and should be assessed and
have diagnostic testing for this pain. The 45-year-old patient may have
abdominal trauma or bleeding and should be seen next to assess circulatory
status. The 30-year-old appears to have a possible fracture of the right leg and
should be seen soon, but this patient has the least life-threatening injury.