Nokea
The nurse is caring for a patient who has sustained a black widow spider bite. When would the nurse expect the symptoms to peak?
- A. 30 minutes
- B. 2-3 hours
- C. 5-6 hours
- D. 9-10 hours
Correct Answer: B
Rationale: Symptoms of a black widow spider bite, caused by neurotoxic venom, typically peak within 2-3 hours as the venom affects the nervous system, causing muscle cramps and pain.
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After spending the previous weekend camping out with friends, a patient presents to the emergency department (ED) and is diagnosed with flaccid ascending paralysis. Based upon this information, the nurse concludes that the patient has been bitten by which of the following?
- A. Spider
- B. Wasp
- C. Tick
- D. Snake
Correct Answer: C
Rationale: Flaccid ascending paralysis developing 5-7 days after tick exposure is characteristic of tick paralysis, caused by a neurotoxin from wood or dog ticks. Removal of the tick typically reverses symptoms within 48-72 hours.
The nurse is conducting a primary survey on a patient in the emergency department (ED) and notes motor posturing in response to noxious stimuli. Which of the following actions should the nurse implement immediately?
- A. Hyperventilate the client
- B. Decrease the IV fluid rate
- C. Prepare for intubation
- D. Continue with the triage assessment
Correct Answer: C
Rationale: Motor posturing (e.g., decorticate or decerebrate) suggests possible brain herniation, requiring immediate preparation for intubation to secure the airway and support oxygenation. Hyperventilation may be considered later, but airway management is the priority.
An unresponsive older-adult patient is admitted to the emergency department (ED) during a summer heat wave. The patient's core temperature is 41.2°C (106.1°F), blood pressure (BP) 86/52, and pulse 102. Which of the following actions should the nurse implement initially?
- A. Administer an Aspirin suppository
- B. Start O2 at 6 L/minute with a nasal cannula
- C. Apply a cooling blanket to the patient
- D. Infuse Lactated Ringer's solution at 1000 mL/hour
Correct Answer: C
Rationale: Applying a cooling blanket is the priority to rapidly lower the core temperature in heat stroke, which is life-threatening at 41.2°C. Aspirin is ineffective, high-flow oxygen via non-rebreather is preferred, and rapid fluid infusion risks pulmonary edema in older adults.
The nurse is conducting a primary survey of a patient with multiple traumatic injuries and observes that the patient's right pedal pulses are absent and the leg is swollen. Which of the following actions will the nurse take next?
- A. Assess further for a cause of the decreased circulation
- B. Send blood to the lab for a complete blood count (CBC)
- C. Finish the airway, breathing, circulation, disability survey
- D. Initiate isotonic fluid infusion through two large-bore IV lines
Correct Answer: D
Rationale: Absent pedal pulses and leg swelling suggest arterial trauma or hemorrhage, a life-threatening condition. Initiating IV fluid infusion immediately addresses potential hypovolemia, taking precedence over further assessment or completing the survey.
These four patients arrive in the emergency department after a motor vehicle crash. In which order should they be assessed?
- A. A 72-year-old with palpitations and chest pain
- B. A 45-year-old complaining of 6/10 abdominal pain
- C. A 22-year-old with multiple fractures of the face and jaw
- D. A 30-year-old with a misaligned right leg with intact pulses
Correct Answer: C,A,B,D
Rationale: The 22-year-old with facial and jaw fractures is assessed first due to potential airway compromise. The 72-year-old with chest pain (possible cardiac ischemia) is next, followed by the 45-year-old with abdominal pain (potential internal bleeding). The 30-year-old with a leg fracture and intact pulses is least urgent.