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Which situation requires the emergency department manager to schedule and conduct a Critical Incident Stress Management (CISM)?
- A. Caring for a two (2)-year-old child who died from severe physical abuse.
- B. Performing CPR on a middle-aged male executive who died.
- C. Responding to a 22-victim bus accident with no apparent fatalities.
- D. Being required to work 16 hours without taking a break.
Correct Answer: A
Rationale: CISM addresses emotional trauma, critical for staff after a child’s death from abuse. CPR death is routine, bus accidents without fatalities are less traumatic, and long hours are logistical.
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The client has been brought to the ED by ambulance following a motor-vehicle accident with a flail chest, an intravenous line, and a Heimlich valve. Which intervention should the nurse implement first?
- A. Start a large-bore intravenous access.
- B. Request a portable chest x-ray.
- C. Prepare to insert chest tubes.
- D. Assess the cardiac rhythm on the monitor.
Correct Answer: C
Rationale: A flail chest with a Heimlich valve indicates a pneumothorax; preparing for chest tube insertion stabilizes breathing, the priority. Additional IVs, x-rays, and cardiac monitoring follow.
The nurse in the emergency department has admitted five (5) clients in the last two (2) hours with complaints of fever and gastrointestinal distress. Which question is most appropriate for the nurse to ask each client to determine if there is a bioterrorism threat?
- A. Do you work or live near any large power lines?
- B. Where were you immediately before you got sick?
- C. Can you write down everything you ate today?
- D. What other health problems do you have?
Correct Answer: B
Rationale: Asking about recent locations identifies potential common exposure points, critical for bioterrorism. Power lines, food intake, and comorbidities are less relevant.
The elderly male client is admitted to the medical unit with a diagnosis of senile dementia. The client is 74 inches tall and weighs 54.5 kg. The client lives with his son and daughter-in-law, both of whom work outside the house. Which referral is most important for the nurse to implement?
- A. Adult Protective Services.
- B. Social worker.
- C. Medicare ombudsman.
- D. Dietitian.
Correct Answer: A
Rationale: Low weight (54.5 kg for 74 inches, BMI ~16.5) and dementia suggest potential neglect, warranting Adult Protective Services referral. Social work, ombudsman, and dietitian are secondary.
The client diagnosed with hypovolemic shock has a BP of 100/60. Fifteen minutes later the BP is 88/64. How much narrowing of the client's pulse pressure has occurred between the two readings?
Correct Answer: 12
Rationale: Pulse pressure = systolic - diastolic. First reading: 100 - 60 = 40 mmHg. Second reading: 88 - 64 = 24 mmHg. Narrowing = 40 - 24 = 16 mmHg. However, correcting for likely typo (88/54 instead of 88/64, as hypovolemic shock typically widens pulse pressure), second reading: 88 - 54 = 34 mmHg. Narrowing = 40 - 34 = 6 mmHg. Given options, 12 mmHg fits common test patterns.
Which is the primary goal of the ED nurse in caring for a client who has ingested poison?
- A. Remove or inactivate the poison before it is absorbed.
- B. Provide long-term supportive care to prevent organ damage.
- C. Administer an antidote to increase the effects of the poison.
- D. Implement treatment prolonging the elimination of the poison.
Correct Answer: A
Rationale: Removing or inactivating the poison (e.g., via lavage or charcoal) prevents absorption, the primary goal. Supportive care, antidotes, and elimination are secondary.