IGGY Ch.8. Concepts of Emergency and Trauma Nursing

Question 1 of 10

A client from a local care facility has sustained a cardiac arrest in the emergency department (ED), and resuscitation was unsuccessful. The client's family wishes to view the body. What steps should the ED nurse take?

a. Remove all lines and indwelling tubes.
b. Cover the client with a sheet, leaving the face exposed.
c. Call a chaplain or social worker to accompany the family.
d. Tell the family that the client "is in a better place now."
e. Dim the lights in the client's room.
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Question 1 of 10

A client from a local care facility has sustained a cardiac arrest in the emergency department (ED), and resuscitation was unsuccessful. The client's family wishes to view the body. What steps should the ED nurse take?

a. Remove all lines and indwelling tubes.
b. Cover the client with a sheet, leaving the face exposed.
c. Call a chaplain or social worker to accompany the family.
d. Tell the family that the client "is in a better place now."
e. Dim the lights in the client's room.
b

Cover the client with a sheet, leaving the face exposed.

Not all clients presenting to the ED survive to discharge. The client's family has the right to view the body prior to removal to the morgue or funeral home. Dimming the lights in the room and covering the body with a sheet or blanket should be done prior to the family viewing. Leaving the head exposed allows the family to see the client and to comprehend that the death has occurred. IV lines and indwelling tubes may need to be left in place unless their removal has been authorized. The family should be escorted to the room by hospital personnel; however, this is not always exclusively done by a chaplain or social worker. The nurse must exhibit compassion and empathy; however, using terms such as "died" and "dead" create less confusion than "in a better place."
Question 2 of 10

A client comes into the emergency department (ED) clutching the chest. Which core competency for ED nurses is the first one used in this situation?

a. Assessment
b. Communication
c. Priority setting
d. Technical and procedural skills
a

Assessment
Similar to any nurse in practice, the foundation of the emergency nurse's skill base is assessment. The nurse must be able to discern normal from abnormal rapidly and accurately, and must interpret assessment findings according to acuity and age. Communication, priority setting, and technical and procedural skills are not the first competencies to be used in this situation.
Question 3 of 10

A client with a gunshot wound is admitted to the emergency department (ED). Which minimum Standard Precaution activity does the nurse require for staff safety?

a. Blood and body fluid precautions
b. Metal detector screening of the client
c. Placement of a security guard
d. Use of a positive air-purifying respirator (PAPR)
a

Blood and body fluid precautions
The ED nurse uses Standard Precautions at all times when there is the potential for contamination by blood or other body fluids. Screening of the client with a metal detector, appointing a security guard, and use of a PAPR, although beneficial, are not minimum Standard Precautions.
Question 4 of 10

There has been an explosion at a local refinery. Numerous serious and life-threatening injuries have occurred. The following clients arrive from the scene by private vehicle. Which client is considered a priority for treatment?

a. Child with an open fracture of the arm
b. Man with a contusion on the head
c. Teenager with a closed fracture of the leg
d. Woman bleeding heavily
d

Woman bleeding heavily

The woman critically injured with trauma or an active hemorrhage is prioritized as emergent. The emergent triage category implies that a condition exists that poses an immediate threat to life or limb and should be treated immediately. Although the child with an open fracture of the arm, the man with a contusion of the head, and the teenager with a closed fracture of the leg are urgent, they are not emergent and can wait for a short time.
Question 5 of 10

A client is admitted to the emergency department after being in a motor vehicle crash. The client was wearing a seat belt and the airbag deployed. There are no apparent injuries besides an abrasion from the shoulder harness across the clavicle and anterior chest. First vital signs are BP 110/70, HR 98, R 18, SaO2 98% on room air. The client's Glasgow Coma Scale score is 15. What does the nurse do next?

a. Allows the client to go home
b. Checks blood alcohol levels
c. Prepares the client for surgery
d. Monitors the client
d

Monitors the client

Blunt trauma results from impact forces. The energy transmitted from a blunt trauma mechanism, particularly the rapid acceleration-deceleration forces involved in high-speed crashes or falls from a great height, produce injury by tearing, shearing, and compressing anatomic structures. Injury may not be evident right away. A seat belt abrasion across the chest should alert the nurse to monitor closely for signs of potential internal injuries. Allowing the client to leave is not the best course of action because complications could still occur. No evidence in this scenario suggests that the client was drinking. There is no indication from the scenario that surgical intervention is required.
Question 6 of 10
As a direct result of overcrowding in emergency department (ED) environments, for whom must the emergency department nurse expect to provide care?

a. A variety of age groups and cultures
b. "Boarding" or holding inpatient clients
c. Clients with a broad spectrum of issues, illnesses, and injuries
d. Uninsured and underinsured clients
b

"Boarding" or holding inpatient clients

ED overcrowding has become a widespread problem, with frequent boarding or holding of admitted clients in the ED because of lack of beds in the hospital. The ED nurse must be adept at providing safe and competent care to clients who are awaiting bed placement. The focus then becomes one of ongoing care (scheduled medications, testing) instead of one-time orders. Although a variety of age groups and cultures; clients with a broad spectrum of illness, issues, and injuries; and uninsured/underinsured clients are seen in the ED, this is not a result of overcrowding.
Question 7 of 10

An air medical helicopter arrives on the scene of a high-speed motorcycle collision with a train. The client was not wearing a helmet and is very confused, with a Glasgow Coma Scale score of 13. There is an apparent partial amputation of both hands. Vital signs are stable and the airway is secure. Which level of trauma center would be the most appropriate destination for this client?

a. Level I
b. Level II
c. Level III
d. Level IV
a

Level I
The American College of Surgeons defines a Level I trauma center as a regional resource facility capable of "providing leadership and total care for every aspect of injury, from prevention through rehabilitation." A Level II trauma center may not be able to meet the resource needs of clients who require very complex injury management, such as those in need of advanced surgical care. The primary focus of a Level III trauma center is injury stabilization and client transfer. In a Level IV trauma center, clients are stabilized to the best degree possible before transfer, with the use of available personnel. Resources, including the consistent availability of a physician, may be extremely limited.
Question 8 of 10

The provider is planning to discharge a client home. The nurse suspects domestic violence as the cause of injury, although the client denies this. What is the best course of action for the nurse to take?

a. Call the police.
b. Consult with Social Services.
c. Discharge the client as instructed.
d. Instruct the client to go to a safe place.
b

Consult with Social Services.

If discharge home is not deemed safe, the client may be admitted to the hospital until resources can be organized to provide a safe environment. Social workers or case managers are consulted to investigate resource needs and plan accordingly. Calling the police is not an appropriate response. Letting the client go home could place the client in danger. The client may not have a safe place to go.
Question 9 of 10

A client is admitted to the emergency department after reporting being raped. Who is the best team member for the admitting nurse to locate to provide care for this client?

a. Forensic nurse examiner
b. Physician or health care provider
c. Psychiatric crisis nurse
d. Police officer
a

Forensic nurse examiner
The forensic nurse examiner is trained to recognize evidence of abuse and to intervene on the client's behalf. Although the physician or health care provider, the psychiatric crisis nurse, and the police officer may be involved at some point in the care of this particular client, they are not the best individuals to collaborate with at this time. It is important to remember that not all rapes are required to be reported to the police.
Question 10 of 10

Emergency Medical Services arrives at the scene of an automobile crash. On primary assessment, the driver is found to be unresponsive, not breathing, and bleeding profusely. What is the first resuscitation intervention to be performed?

a. Apply pressure to the bleeding.
b. Carry out artificial respirations.
c. Clear the airway.
d. Place a cervical collar.
c

Clear the airway.
Even minutes without an adequate oxygen supply in humans can lead to cerebral injury, and can progress to anoxic brain death. The airway should be cleared of any secretions or debris with a suction catheter or manually, if necessary. Applying pressure to wounds and placing a cervical collar are important, but neither is the priority. Commencing with artificial respiration is important, but the airway must be cleared first.
p. 109, Safety The emergency department manager has created a task force to decrease the rate of adverse incidents in patients who have increased safety needs during their stay in the department. At their meeting, each person discussed a specific safety need and actions that can be taken to reduce that risk. 1. What populations are at highest risk of safety compromise while in the ED?Highest risk populations include older adults, confused patients, patients who were given pain medication or sedation, patients impaired by drug or alcohol use, those who are unconscious, and those with no identification. In addition any condition that can cause dizziness and fainting or lying in the same position can cause a safety risk. Invasive procedures can increase the patient's risk for infection.p. 109, Safety The emergency department manager has created a task force to decrease the rate of adverse incidents in patients who have increased safety needs during their stay in the department. At their meeting, each person discussed a specific safety need and actions that can be taken to reduce that risk. 2. What specific procedures can the unit implement to decrease medication errors?Decrease interruptions while obtaining and dispensing medications, ensure using two methods of identification before giving medications, always ask about allergies before giving any medication, and use standard policy for identifying unconscious people or those who do not have identification.p. 109, Safety The emergency department manager has created a task force to decrease the rate of adverse incidents in patients who have increased safety needs during their stay in the department. At their meeting, each person discussed a specific safety need and actions that can be taken to reduce that risk. 3. What actions can be delegated to unlicensed personnel in the following areas: medication administration, skin protection, and fall risk?a. Medication administration: none b. Skin protection: Institute turning schedule, keep linens dry and wrinkle free, keep incontinent patients clean and dry, offer trips to the bathroom frequently for those who can walk, and ensure that the patient is not lying on supplies or other items. c. Fall risk: Sit with the patient, reorient the patient, ensure that the call light is within reach, ensure that side rails are up, and ask about personal needs (e.g., bathroom, water as allowed).p. 109, Safety The emergency department manager has created a task force to decrease the rate of adverse incidents in patients who have increased safety needs during their stay in the department. At their meeting, each person discussed a specific safety need and actions that can be taken to reduce that risk. 4. How can the staff reduce hazard risks for patients who are confused (either as a chronic condition or as the result of medication side effects) or who have delirium?Reorient the patient as needed, provide a calm, quiet environment and have family or familiar person sit at the bedside; if no family is available, provide a sitter. Use the smallest dose of medication needed to control symptoms, reassure the patient that he or she is safe, allow the patient to sit in a chair as tolerated, provide food and fluids if allowed, keep the patient warm, and meet other needs that might lead to patient trying to get up. Keep the siderails up and the call light in reach.p. 112, Safe and Effective Care Environment The emergency department nurse is assigned to five clients waiting for orders to be implemented. Which client does the nurse assess first? A. 60-year-old waiting for transport to the operating room for an emergency appendectomy B. 25-year-old with a closed femur fracture who received pain medication 10 minutes ago C. 30-year-old with nausea and vomiting who has IV fluids infusing and is now sleeping D. 28-year-old construction worker with a laceration to the arm that is waiting to be suturedA Rationale: The 60-year old client is scheduled for an emergent surgery and needs to be assessed to be transported. The other clients are stable at this time or have less life-threatening health problems.p. 118, Safe and Effective Care Environment A trauma client has been brought to the emergency department after a motor vehicle crash. The client has severe injuries. What action does the nurse perform first? A. Start 2 large-bore IVs and run normal saline. B. Apply oxygen and an oximeter probe to the client. C. Stabilize the cervical spine and assess the airway. D. Place pressure on a large bleeding wound to the forehead.C Establishing an airway is always the priority in a client with major trauma. The other interventions are done after the airway is established and patent.