Prepared By: Charles Anthony Esteban EMERGENCY ROOM QUESTIONS 1.

A client with multiple injury following a vehicular accident is transferred to the critical care unit. He begins to complain of increased abdominal pain in the left upper quadrant. A ruptured spleen is diagnosed and he is scheduled for emergency splenectomy. In preparing the client for surgery, the nurse should emphasize in his teaching plan the: a. Complete safety of the procedure b. Expectation of postoperative bleeding c. Risk of the procedure with his other injuries d. Presence of abdominal drains for several days after surgery 2. After you managed to stabilize the respiratory function of your burn patient, your next goal is to prevent this you have to replace the lost fluid and electrolytes. In starting fluid replacement therapy, the total volume and rate of IV fluid repalcement are gauged by the patients response and by the patients response and by the resuscitation formula. In determining the adequacy of fluid resuscitation, it is essential for you to monitor the: a. urine output b. blood pressure c. intracranial pressure d. cardiac output 3. You are a nurse in the emergency department and it is during the shift that Mr. CT is admitted in the area due to a fractured skull from a motor accident. You scheduled him for surgery under which classification? a. Urgent b. Emergent c. Required d. Elective 4. Lucky was in a vehicular acccident where he sustained injury to his left ankle. In the Emergency room, you noticed anxious he looks. You establish rapport with him and to reduce his anxiety, you initially: a. Identify yourself and state your purpose in being with the client b. Take him to the radiology section for x-ray of affected extremity c. Talk to the physician for an order of valium d. Do inspection and palpation to check extent of his injuries 5. The client diagnosed with a mild concussion is being discharged from the emergency department. Which discharge instruction should the nurse teach the clients significant other? a. Awaken the client every two hours. b. Monitor for increased intracranial pressure. c. Observe frequently for hypervigilance. d. Offer the client food every three to four hours. 6. The client diagnosed with Addisons disease is admitted to the emergency department after a day at the lake. The client is lethargic, forgetful, and weak. Which intervention should be the emergency department nurses first action? a. Start an IV with an 18-gauge needle and infuse NS rapidly. b. Have the client wait in the waiting room until a bed is available. c. Perform a complete head-to-toe assessment. d. Collect urinalysis and blood samples for a CBC and calcium level.

Prepared By: Charles Anthony Esteban 7. A client is admitted from the emergency department with severe-pain and edema in the right foot. His diagnosis is gouty arthritis. When developing a plan of care, which action would have the highest priority? a. Apply hot compresses to the affected joints. b. Stress the importance of maintaining good posture to prevent deformities. c. Administer salicylates to minimize the inflammatory reaction. d. Ensure an intake of at least 3000 ml of fluid per day. 8. The triage nurse is working in the emergency department. Which client should be assessed first? a. The 10-year-old child whose dad thinks the childs leg is broken. b. The 45-year-old male who is diaphoretic and clutching his chest. c. The 58-year-old female complaining of a headache and seeing spots. d. The 25-year-old male who cut his hand with a hunting knife. 9. According to the North Atlantic Treaty Organization (NATO) triage system, which situation would be considered a level red (Priority 1)? a. Injuries are extensive and chances of survival are unlikely. b. Injuries are minor and treatment can be delayed hours to days. c. Injuries are significant but can wait hours without threat to life or limb. d. Injuries are life threatening but survivable with minimal interventions. 10. Which statement best describes the role of the medical-surgical nurse during a disaster? a. The nurse may be assigned to ride in the ambulance. b. The nurse may be assigned as a first assistant in the operating room. c. The nurse may be assigned to crowd control. d. The nurse may be assigned to the emergency department. 11. Which nursing intervention would be appropriate when caring for a client who has sustained an electrical burn? a. Applying ice to the burned area b. Flushing the burn area with large amounts of water c. Monitoring the client with cardiac telemetry d. Preparing to administer the chemical antidote 12. Eddie, 40 years old, is brought to the emergency room after the crash of his private plane. He has suffered multiple crushing wounds of the chest, abdomen and legs. It is feared his leg may have to be amputated. When Eddie arrives in the emergency room, the assessment that assume the greatest priority are: a. Level of consciousness and pupil size b. Abdominal contusions and other wounds c. Pain, Respiratory rate and blood pressure d. Quality of respirations and presence of pulses. 13. An emergency treatment for an acute asthmatic attack is Adrenaline 1:1000 given hypodermically. This is given to: a. increase BP b. decrease mucosal swelling c. relax the bronchial smooth muscle d. decrease bronchial secretions

Prepared By: Charles Anthony Esteban 14. Intervention for a pt. who has swallowed a Muriatic Acid includes all of the following except a. administering an irritant that will stimulate vomiting b. aspirating secretions from the pharynx if respirations are affected c. neutralizing the chemical d. washing the esophagus with large volumes of water via gastric lavage 15. John, 16 years old, is brought to the ER after a vehicular accident. He is pronounced dead on arrival. When his parents arrive at the hospital, the nurse should: a. ask them to stay in the waiting area until she can spend time alone with them b. speak to both parents together and encourage them to support each other and express their emotions freely c. Speak to one parent at a time so that each can ventilate feelings of loss without upsetting the other d. ask the MD to medicate the parents so they can stay calm to deal with their sons death. 16. A nurse is eating in the hospital cafeteria when a toddler at a nearby table chokes on a piece of food and appears slightly blue. The appropriate initial action should be to a. Begin mouth to mouth resuscitation b. Give the child water to help in swallowing c. Perform 5 abdominal thrusts d. Call for the emergency response team 17. A client is admitted from the emergency department with severe-pain and edema in the right foot. His diagnosis is gouty arthritis. When developing a plan of care, which action would have the highest priority? a. Apply hot compresses to the affected joints. b. Stress the importance of maintaining good posture to prevent deformities. c. Administer salicylates to minimize the inflammatory reaction. d. Ensure an intake of at least 3000 ml of fluid per day. 18. The Heimlich maneuver (abdominal thrust), for acute airway obstruction, attempts to: a. Force air out of the lungs b. Increase systemic circulation c. Induce emptying of the stomach d. Put pressure on the apex of the heart 19. A nurse is performing CPR on an adult patient. When performing chest compressions, the nurse understands the correct hand placement is located over the a. upper half of the sternum b. upper third of the sternum c. lower half of the sternum d. lower third of the sternum 20. John, 16 years old, is brought to the ER after a vehicular accident. He is pronounced dead on arrival. When his parents arrive at the hospital, the nurse should: a. ask them to stay in the waiting area until she can spend time alone with them b. speak to both parents together and encourage them to support each other and express their emotions freely c. Speak to one parent at a time so that each can ventilate feelings of loss without upsetting the other d. ask the MD to medicate the parents so they can stay calm to deal with their sons death.

Prepared By: Charles Anthony Esteban

ANSWER KEY: ER QUESTIONS 1. Answer: D Rationale: Presence of abdominal drains for several days after surgery Drains are usually inserted into the splenic bed to facilitate removal of fluid in the area that could lead to abscess formation. 2. Answer: A Rationale: to establish the sufficiency of fluid resuscitation, urine output totals an index of renal perfusion. Urine output totals an index of renal perfusion, urine output totals of 30-50 ml/hour have been used as resuscitation goals. Other indicators of adequate fluid replacement are systolic blood pressure exceeding 100 mmHg, a pulse rate less than110 beats/min or both. 3. Answer: B Rationale: Emergent surgery is performed, immediately without delay to maintain life, limb or organ, remove damage and stop bleeding. Urgent surgery requires prompt attention and is done few hours but within 24 to 48 hours. Required surgery is done within a few weeks as surgery is important. Elective surgery is scheduled and done at the convenience of client as failure to have surgery is not catastrophic. Optional surgeries are done by preference only. 4. Answer: A Rationale: Introducing self initiates the nurse-patient interaction, relationship and the purpose of being with the client. This prevents confusion and let the client know what to expect, thereby reducing anxiety. 5. Answer: A Rationale: Awakening the client every 2 hours allows the identification of headache, dizziness, lethargy, irritability, and anxietyall signs of post-concussion syndromethat would warrant the significant others taking the client back to the emergency department. 6. Answer: A Rationale: This client has been exposed to wind and sun at the lake during the hours prior to being admitted to the emergency department. This predisposes the client to dehydration and an Addisonian crisis. Rapid IV fluid replacement is necessary. 7. Answer: D Rationale: Ensure an intake of at least 3000 ml of fluid per day. Gouty arthritis is a metabolic disease marked by urate deposits that cause painful arthritic joints. The patient should be urged to increase his fluid intake to prevent the development of urinary uric acid stones. 8. Answer: B Rationale: The triage nurse should see this client first because these are symptoms of a myocar- dial infarction, which potentially life is threatening. 9. Answer: D Rationale: This is called the immediate category. Individuals in this group can progress rapidly to expectant if treatment is delayed. 10. Answer: D Rationale: New settings and atypical roles for nurses may be required during disasters; medical-surgical nurses can provide first aid and be required to work in unfamiliar settings 11. Answer: C Rationale: Because of the effects of the electrical current on the cardiovascular system, all clients experiencing

Prepared By: Charles Anthony Esteban

electrical burns should be placed on a cardiac monitor. Applying ice is inappropriate for any type of burn. Only chemical burns should be flushed with large amounts of water. Chemical antidotes may be used for chemical burns for which an antidote has been identified. 12. Answer: D Rationale: Respiratory and cardiovascular functions are essential for oxygenation. These are top priorities to trauma management. Basic life functions must be maintained or reestablished 13. Answer: C Rationale: Acute asthmatic attack is characterized by severe bronchospasm which can be relieved by the immediate administration of bronchodilators. Adrenaline or Epinephrine is an adrenergic agent that causes bronchial dilation by relaxing the bronchial smooth muscles. 14. Answer: A Rationale: Swallowing of corrosive substances causes severe irritation and tissue destruction of the mucous membrane of the GI tract. Measures are taken to immediately remove the toxin or reduce its absorption. For corrosive poison ingestion, such as in muriatic acid where burn or perforation of the mucosa may occur, gastric emptying procedure is immediately instituted, This includes gastric lavage and the administration of activated charcoal to absorb the poison. Administering an irritant with the concomitant vomiting to remove the swallowed poison will further cause irritation and damage to the mucosal lining of the digestive tract. Vomiting is only indicated when non-corrosive poison is swallowed. 15. Answer: B Rationale: Sudden death of a family member creates a state of shock on the family. They go into a stage of denial and anger in their grieving. Assisting them with information they need to know, answering their questions and listening to them will provide the needed support for them to move on and be of support to one another. 16. Answer: C Rationale: Perform 5 abdominal thrusts. At this age, the most effective way to clear the airway of food is to perform abdominal thrusts. 17. Answer: D Rationale: Ensure an intake of at least 3000 ml of fluid per day. Gouty arthritis is a metabolic disease marked by urate deposits that cause painful arthritic joints. The patient should be urged to increase his fluid intake to prevent the development of urinary uric acid stones. 18. Answer: A Rationale: The Heimlich maneuver is used to assist a person choking on a foreign object. The pressure from the thrusts lifts the diaphragm, forces air out of the lungs and creates an artificial cough that expels the aspirated material. 19. Answer: C Rationale: The exact and safe location to do cardiac compression is the lower half of the sternum. Doing it at the lower third of the sternum may cause gastric compression which can lead to a possible aspiration. 20. Answer: B Rationale: Sudden death of a family member creates a state of shock on the family. They go into a stage of denial and anger in their grieving. Assisting them with information they need to know, answering their questions and listening to them will provide the needed support for them to move on and be of support to one another.