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A patient with multiple serious injuries sustained in a motorcycle accident is lying beside his wrecked motorcycle unconscious and bleeding when the rescuer arrives at the scene. What will be the rescuer's priority action?
- A. Assessing blood loss
- B. Assessing respiratory status
- C. Obtaining vital signs
- D. Organizing laypeople at the scene
Correct Answer: B
Rationale: Priority intervention is to assess respiratory status.
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A farm worker who has been kicked in the stomach by a mule passes a foul black tarry stool. What is this called?
- A. Loose stool
- B. Melena
- C. Hematuria
- D. Hemoptysis
Correct Answer: B
Rationale: When internal bleeding occurs, the patient may demonstrate hemoptysis (bloody sputum), hematemesis (bloody vomit), melena (foul black tarry stool), or hematuria (bloody urine).
When assessing a patient who has suffered a burn injury the nurse classifies the burn as a deep partial-thickness burn. What is this observation most likely based upon?
- A. Painful reddened skin
- B. Charred skin with milky-white areas
- C. Erythema and blisters
- D. Erythema pain and swelling
Correct Answer: C
Rationale: With deep partial-thickness burns, blister formation may be seen with erythema.
The patient with heatstroke has been undressed and treated with cold packs and a fan. The patient's temperature is now down to 101.2°F (38.4°C). The patient starts to shiver. What action should the emergency department nurse take?
- A. Raise the head of the bed.
- B. Offer warm liquids.
- C. Remove cold packs and fan.
- D. Continue with cooling interventions.
Correct Answer: C
Rationale: The cooling techniques have caused the patient to shiver, which will increase the patient's temperature.
A patient arrives in the emergency department with a sucking wound to the left chest. What is the first action the nurse should take?
- A. Place several layers of gauze dressing over the wound.
- B. Place the patient in a supine position.
- C. Cover the wound with an airtight dressing taped on three sides.
- D. Turn the patient to the left side.
Correct Answer: C
Rationale: Sucking chest wounds should be dressed with a flutter dressing so that air can escape the pleural space, but no more air can be sucked in.
If a spinal injury is suspected before the rescuer starts CPR the trachea should be opened with a __ maneuver.
Correct Answer: thrust
Rationale: The jaw-thrust maneuver does not hyperextend the neck.