1.

Which patient should the nurse prioritize as needing emergent treatment, assuming no other
injuries are present except the ones outlined below?

A) A patient with a blunt chest trauma with some difficulty breathing

B) A patient with a sore neck who was immobilized in the field on a backboard with a cervical
collar
C) A patient with a possible fractured tibia with adequate pedal pulses
D) A patient with an acute onset of confusion

Ans: A
Feedback:
The patient with blunt chest trauma possibly has a compromised airway. Establishment and
maintenance of a patent airway and adequate ventilation is prioritized over other health
problems, including skeletal injuries and changes in cognition.

2. The nurse observes that the family members of a patient who was injured in an accident are
blaming each other for the circumstances leading up to the accident. The nurse appropriately
lets the family members express their feelings of responsibility, while explaining that there was
probably little they could do to prevent the injury. In what stage of crisis is this family?

A) Anxiety and denial

B) Remorse and guilt
C) Anger
D) Grief

Ans: B
Feedback:
Remorse and guilt are natural processes of the stages of a crisis and should be facilitated for
the family members to process the crisis. The familys sense of blame and responsibility are
more suggestive of guilt than anger, grief, or anxiety.

3. A patient is brought to the ED by ambulance with a gunshot wound to the abdomen. The
nurse knows that the most common hollow organ injured in this type of injury is what?
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A) Liver
B) Small bowel
C) Stomach
D) Large bowel

Ans: B
Feedback:
Penetrating abdominal wounds have a high incidence of injury to hollow organs, especially the
small bowel. The liver is also injured frequently, but it is a solid organ.

4. A patient has been brought to the ED with multiple trauma after a motor vehicle accident.
After immediate threats to life have been addressed, the nurse and trauma team should take
what action?

A) Perform a rapid physical assessment.

B) Initiate health education.
C) Perform diagnostic imaging.
D) Establish the circumstances of the accident.

Ans: A
Feedback:
Once immediate threats to life have been corrected, a rapid physical examination is done to
identify injuries and priorities of treatment. Health education is initiated later in the care process
and diagnostic imaging would take place after a rapid physical assessment. It is not the care
teams responsibility to determine the circumstances of the accident.

5. The nursing educator is reviewing the signs and symptoms of heat stroke with a group of
nurses who provide care in a desert region. The educator should describe what sign or
symptom?

A) Hypertension with a wide pulse pressure

B) Anhidrosis
C) Copious diuresis
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D) Cheyne-Stokes respirations

Ans: B
Feedback:
Heat stroke is manifested by anhidrosis confusion, bizarre behavior, coma, elevated body
temperature, hot dry skin, tachypnea, hypotension, and tachycardia. This health problem is not
associated with anhidrosis or Cheyne-Stokes respirations.

6. When assessing patients who are victims of a chemical agent attack, the nurse is aware that
assessment findings vary based on the type of chemical agent. The chemical sulfur mustard is
an example of what type of chemical warfare agent?

A) Nerve agent
B) Blood agent
C) Pulmonary agent
D) Vesicant

Ans: D
Feedback:
Sulfur mustard is a vesicant chemical that causes blistering and results in burning, conjunctivitis,
bronchitis, pneumonia, hematopoietic suppression, and death. Nerve agents include sarin,
soman, tabun, VX, and organophosphates (pesticides). Hydrogen cyanide is a blood agent that
has a direct effect on cellular metabolism, resulting in asphyxiation through alterations in
hemoglobin. Chlorine is a pulmonary agent, which destroys the pulmonary membrane that
separates the alveolus from the capillary bed.
7. A major earthquake has occurred within the vicinity of the local hospital. The nursing
supervisor working the night shift at the hospital receives information that the hospital disaster
plan will be activated. The supervisor will need to work with what organization responsible for
coordinating interagency relief assistance?
A) Office of Emergency Management
B) Incident Command System
C) Centers for Disease Control and Prevention (CDC)
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D) American Red Cross

Ans: A
Feedback:
The Office of Emergency Management coordinates the disaster relief efforts at state and local
levels. The Incident Command System is a management tool to organize personnel, facilities,
equipment, and communication in an emergency situation. The CDC is the agency for disease
prevention and control and it supports state and local health departments. The American Red
Cross provides additional support.

8. While developing an emergency operations plan (EOP), the committee is discussing the
components of the EOP. During the post-incident response of an emergency operations plan,
what activity will take place?

A) Deciding when the facility will go from disaster response to daily activities
B) Conducting practice drills for the community and facility
C) Conducting a critique and debriefing for all involved in the incident
D) Replacing the resources in the facility

Ans: C
Feedback:
A post-incident response includes critiquing and debriefing all parties involved immediately and
at later dates. It does not include the decision to go from disaster response to daily activities; it
does not include practice drills; and it does not include replacement of resources in the facility.

9. The announcement is made that the facility may return to normal functioning after a local
disaster. In the emergency operations plan, what is this referred to as?
A) Demobilization response
B) Post-incident response
C) Crisis diffusion
D) Reversion

Ans: A
Feedback:
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The demobilization response occurs when it is deemed that the facility may return to normal
daily functioning. This is not known as the post-incident response, crisis diffusion or reversion.

10. A group of disaster survivors is working with the critical incident stress management (CISM)
team.
Members of this team should be guided by what goal?
A) Determining whether the incident was managed effectively
B) Educating survivors on potential coping strategies for future disasters
C) Providing individuals with education about recognizing stress reactions
D) Determining if individuals responded appropriately during the incident
Ans: C
Feedback:
In defusing, patients are given information about recognizing stress reactions and how to deal
with handling the stress they may experience. Debriefing involves asking patients about their
current emotional coping and symptoms, following up, and identifying patients who require
further assessment and assistance in dealing with the stress experienced. The CISM team does
not focus primarily on the management of the incident or on providing skills for future incidents.
11. Level C personal protective equipment has been deemed necessary in the response to an
unknown substance. The nurse is aware that the equipment will include what?
A) A self-contained breathing apparatus
B) A vapor-tight, chemical-resistant suit
C) A uniform only
D) An air-purified respirator

Ans: D
Feedback:
Level C incorporates the use of an air-purified respirator, a chemical resistant coverall with
splash hood, chemical-resistant gloves, and boots. Level A provides the highest level of
respiratory, mucous membrane, skin, and eye protection, incorporating a vapor-tight, chemical-
resistant suit and selfcontained breathing apparatus (SCBA). Level B personal protective
equipment provides the highest level of respiratory protection, with a lesser level of skin and eye
protection, incorporating a chemicalresistant suit and SCBA. Level D is the same as a work
uniform.
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12. Emergency department (ED) staff members have been trained to follow steps that will
decrease the risk of secondary exposure to a chemical. When conducting decontamination, staff
members should remove the patients clothing and then perform what action?

A) Rinse the patient with water.

B) Wash the patient with a dilute bleach solution.
C) Wash the patient chlorhexidine.
D) Rinse the patient with hydrogen peroxide.

Ans: A
Feedback:
The first step in decontamination is removal of the patients clothing and jewelry and
then rinsing the patient with water. This is usually followed by a wash with soap and water, not
chlorhexidine, bleach, or hydrogen peroxide.

13. A nurse takes a shift report and finds he is caring for a patient who has been exposed to
anthrax by inhalation. What precautions does the nurse know must be put in place when
providing care for this patient?

A) Standard precautions
B) Airborne precautions
C) Droplet precautions
D) Contact precautions

Ans: A
Feedback:
The patient is not contagious, and anthrax cannot be spread from person to person, so standard
precautions are initiated. Airborne, contact, and droplet precautions are not necessary.

14. A group of medical nurses are being certified in their response to potential bioterrorism. The
nurses learn that if a patient is exposed to the smallpox virus he or she becomes contagious at
what time?

A) 6 to 12 hours after exposure

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B) When pustules form
C) After a rash appears
D) When the patient becomes febrile

Ans: C
Feedback:
A patient is contagious after a rash develops, which initially develops on the face, mouth,
pharynx, and forearms. The patient exposed to the smallpox virus is not contagious immediately
after exposure; only when pustules form, or with a body temperature of 38C.

15. A patient is being treated in the ED following a terrorist attack. The patient is experiencing
visual disturbances, nausea, vomiting, and behavioral changes. The nurse suspects this patient
has been exposed to what chemical agent?

A) Nerve agent
B) Pulmonary agent
C) Vesicant
D) Blood agent

Ans: A
Feedback:
Nerve agent exposure results in visual disturbances, nausea and vomiting, forgetfulness,
irritability, and impaired judgment. This presentation is not suggestive of vesicants, pulmonary
agents, or blood agents.

16. A patient is brought to the ER in an unconscious state. The physician notes that the patient
is in need of emergency surgery. No family members are present, and the patient does not have
identification. What action by the nurse is most important regarding consent for treatment?

A) Ask the social worker to come and sign the consent.

B) Contact the police to obtain the patients identity.
C) Obtain a court order to treat the patient.
D) Clearly document LOC and health status on the patients chart.

Ans: D
Feedback:
When patients are unconscious and in critical condition, the condition and situation should be
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documented to administer treatment quickly and timely when no consent can be obtained by
usual routes. A social worker is not asked to sign the consent. Finding the patients identity is not
a priority. Obtaining a court order would take too long.

17. A patient is experiencing respiratory insufficiency and cannot maintain spontaneous

respirations. The nurse suspects that the physician will perform which of the following actions?

A) Insert an oropharyngeal airway.

B) Perform the jaw thrust maneuver.
C) Perform endotracheal intubation.
D) Perform a cricothyroidotomy.

Ans: C
Feedback:
Endotracheal tubes are used in cases when the patient cannot be ventilated with an
oropharyngeal airway, which is used in patients who are breathing spontaneously. The jaw
thrust maneuver does not establish an airway and cricothyroidotomy would be performed as a
last resort.

18. A patient is brought by friends to the ED after being involved in a motor vehicle accident.
The patient sustained blunt trauma to the abdomen. What nursing action would be most
appropriate for this patient?

A) Ambulate the patient to expel flatus.

B) Place the patient in a high Fowlers position.
C) Immobilize the patient on a backboard.
D) Place the patient in a left lateral position.

Ans: C
Feedback:
When admitted for blunt trauma, patients must be immobilized until spinal injury is ruled out.
Ambulation, side-lying, and upright positioning would be contraindicated until spinal injury is
ruled out.

19. A backcountry skier has been airlifted to the ED after becoming lost and developing
hypothermia and frostbite. How should the nurse best manage the patients frostbite?

A) Immerse affected extremities in water slightly above normal body temperature.

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B) Immerse the patients frostbitten extremities in the warmest water the patient can tolerate.
C) Gently massage the patients frozen extremities in between water baths.
D) Perform passive range-of-motion exercises of the affected extremities to promote circulation.

Ans: A
Feedback:
Frozen extremities are usually placed in a 37C to 40C (98.6F to 104F) circulating bath for 30- to
40-minute spans. To avoid further mechanical injury, the body part is not handled. Massage is
contraindicated.

20. A patient with a fractured femur presenting to the ED exhibits cool, moist skin, increased
heart rate, and falling BP. The care team should consider the possibility of what complication of
the patients injuries?

A) Myocardial infarction
B) Hypoglycemia
C) Hemorrhage
D) Peritonitis

Ans: C
Feedback:
The signs and symptoms the patient is experiencing suggest a volume deficit from an internal
bleed. That the symptoms follow an acute injury suggests hemorrhage rather than myocardial
infarction or hypoglycemia. Peritonitis would be an unlikely result of a femoral fracture.