Emergencies and Nursing Disaster. NG exam

Robert, a 60-year-old male, was admitted to the hospital with a diagnosis of pneumothorax, a condition where air accumulates in the pleural space, causing the lung to collapse.
To treat his condition, a chest tube was inserted to re-expand the lung by removing the air from the pleural space.
Post-procedure, Robert was placed under close monitoring to ensure the effectiveness of the treatment and to manage any potential complications. The nurse assigned to his care observed that the chest drainage system, which included a water-seal chamber, showed continuous bubbling. 
The nurse, aware of the criticality of correct chest tube function, prepared to assess the situation further to determine the cause and appropriate action needed.

In the case of Robert, what is the likely implication of this observation?

Marie, a 32-year-old female, enters a clinic with complaints of high fever, fatigue, and muscle aches. During her history-taking, she mentions attending a political event in the city a week ago. Later on, she heard that a suspicious package was found at the venue, which raised concerns of a bioterrorism attack among attendees.

Based on her exposure to the political event and her current symptoms, which bioterrorism agent should be highly suspected?

Following a terrorist attack involving multiple explosions, the local emergency department was overwhelmed with patients suffering from various injuries, including burns, shrapnel wounds, and traumatic amputations.
The patients included a 30-year-old female with burns and suspected inhalation injury, a 45-year-old male with shrapnel wounds and a leg amputation, and a 20-year-old male showing signs of respiratory distress.
The emergency team, consisting of physicians, nurses, and other healthcare staff, was mobilized to provide rapid care in this mass casualty scenario.
Nurses were at the forefront of triaging and managing the patients, utilizing their expertise and clinical guidelines in the assessment and treatment of blast injuries.

In this emergency with multiple casualties from a terrorist attack, which two actions by the nursing team best reflect the application of clinical guidelines and tools for assessing and managing blast injuries?

A spinal cord-injured patient is complaining of numbness on the left side and is unable to move the right and left arms. The nurse suspects the patient may be experiencing which type of injury.

Michael, a 28-year-old male, was urgently brought to the emergency department by his friends, who suspected he had overdosed on an unknown medication.
Upon arrival, Michael was unconscious, displaying slow and shallow breathing, which raised immediate concerns about respiratory depression. A physical examination revealed bilateral pupil myosis. 
There was no available information about his medical history or the specific medication involved.
His vital signs were as follows: respiratory rate 6 breaths per minute, heart rate 52 bpm, blood pressure 90/50 mmHg, and oxygen saturation at 88% on room air.
The emergency team quickly initiated supportive measures and prepared for potential interventions specific to a suspected overdose.
Given the critical nature of Michael's condition, the nursing team was tasked with identifying and implementing the most appropriate immediate, non-essential, and contraindicated actions for his care.

In the case of Michael, which are the most immediate (indicated), non-essential (not necessary), and contraindicated nursing actions?

A 32-year-old woman, G2P1, is admitted at 34 weeks of gestation with painless, bright red vaginal bleeding. An ultrasound confirms the presence of placenta previa.
Her vital signs are stable, and there is no evidence of active labor.

Which of the following is the most appropriate initial therapeutic intervention for this patient?

A patient presents to the emergency department with nausea, vomiting, colicky abdominal pain, fever, and tachycardia. The healthcare provider informs the nurse that the patient probably has a strangulated intestinal obstruction with perforation.

and are administered followed by to decompress the stomach and intestine. and are performed as soon as possible to detect the location of the obstruction and guide surgical decisions. The patient is prepared for

Mark, a 62-year-old male, arrives at the emergency department with severe chest pain, diaphoresis, and shortness of breath. His vital signs indicate hypotension and tachycardia.

Which actions are indicated and which are not when the nurse prioritizes Mark's condition? 

Emily, a 28-year-old woman, is admitted to the hospital with partial-thickness burns covering her left arm and upper chest area. The burned skin appears red, blistered, and moist.

Which interventions should the nurse implement in the care of Emily's burns? Select all that apply.

Mark Johnson, a 50-year-old Caucasian male, presented to the emergency department with acute onset of severe pain in his right eye, accompanied by photophobia and significant changes in his vision. He described the sensation as a "curtain coming down over his field of vision."
Mark reported no significant past ocular history but mentioned occasional floaters in his vision over the past few months.
On examination, his vital signs were: blood pressure 135/85 mmHg, heart rate 78 bpm, and respiratory rate 16 breaths per minute.
The emergency department’s ophthalmologist conducted a thorough assessment, which confirmed the diagnosis of retinal detachment in his right eye.
This condition, if not promptly and appropriately managed, can lead to permanent vision loss.
The ophthalmologist explained the urgency of the situation to Mark and the need for immediate intervention. The nursing team was instructed to prepare Mark for potential surgery and to provide pre-operative care.

Given the diagnosis of retinal detachment in Mark Johnson, prioritize the nursing interventions. Select all that apply.

Jennifer, a 35-year-old woman, presents to the emergency department with difficulty breathing, a fever, and a rash. She reports she recently attended a large public event and noticed many people coughing. Two days after the event the news reports a possible bioterrorism attack in the vicinity.

Complete the diagram by selecting from the choices below to specify which condition the client is most likely experiencing, 2 actions the nurse would take to address that condition, and 2 possible diagnostic tests the nurse would monitor to assess the client's diagnosis.

As the chief nursing officer of a large urban hospital, Jessica is tasked with developing a disaster preparedness plan due to the increasing global health threats and natural disasters. Before she can create an effective plan, she needs to conduct a gap analysis to identify the hospital's current strengths and weaknesses in disaster preparedness.

To ensure that her team is well-informed and able to conduct a comprehensive gap analysis, which resource should Jessica and her nurse managers prioritize to access critical knowledge about disaster planning?

Mr. G, a 58-year-old man with a history of type 1 diabetes, is brought to the emergency department by his wife. He was found semi-conscious at home with slurred speech and confusion.
His wife reports that he had been managing his diabetes with insulin but had missed his evening meal.

On examination, Mr. G is drowsy but responsive to painful stimuli.

In the emergency treatment of Mr. G, which of the following two interventions is the most appropriate?

Douglas, a 25-year-old construction worker, experienced a traumatic incident while operating heavy machinery at his worksite, resulting in the amputation of his right hand at the wrist level.
Emergency services responded promptly, and Douglas was rushed to the nearest hospital.
The medical team immediately initiated measures to stabilize his condition, including fluid resuscitation and pain management. The amputation site was carefully assessed, revealing a clean severance with significant blood loss.
Efforts were made to control the bleeding and to prepare Douglas for potential surgical intervention.
The nursing team was acutely aware of the various critical implications associated with traumatic amputation. 

In managing a patient like Douglas, who has experienced a traumatic amputation at the wrist, what a two critical nursing implications to consider for his care?

Sarah, a 7-year-old girl, is brought to the emergency department by her parents. She is experiencing difficulty breathing, high-pitched crowing sounds, and visible retractions in the neck area.

What term best describes the breathing sound Sarah is experiencing?

Jenna, a seasoned traveling nurse with years of experience in various settings, recently took a new assignment at Riverdale Medical Center. Although well-versed in many clinical situations, she's new to the intricacies and protocols of this specific emergency department. As the nurse manager evaluates the best place for Jenna, considering both her experience and her unfamiliarity with the current hospital's protocols, where should she be assigned?

For an experienced traveling nurse in their first week at a new hospital's emergency department, which of the following would be the best assignment?

John, a 25-year-old man with a history of epilepsy, experiences a sudden convulsive episode. He falls to the ground, loses consciousness, and exhibits rhythmic jerking movements.

Which three (3) actions should the nurse take during and immediately following the seizure? 

A 25-year-old female is found unresponsive at home by a friend, who immediately calls 911. Upon arrival of EMS, the patient is observed with shallow breathing, pinpoint pupils, and cyanosis around the lips.
A fentanyl patch is discovered on her upper arm, and several pill bottles, including a prescription for benzodiazepines, are found nearby.
What is the most appropriate initial action in the management of this patient?

It's a quiet afternoon in the Acute Care Wing of Northside Hospital. Nurse Lydia is reviewing charts when suddenly, loud noises that sound eerily like gunshots echo from the direction of the main entrance. Moments later, an overhead announcement confirms there's an active shooter situation nearby.

Given the immediacy of the threat, what is the primary role of Nurse Lydia?

Emma Thompson, a 25-year-old female, arrived at the emergency department in a state of distress, experiencing sudden and profuse epistaxis (nosebleed). On arrival, she appeared pale and anxious, holding her head forward while pinching her nostrils in an attempt to control the bleeding.
Emma reported that the nosebleed started spontaneously and had been continuous for approximately 20 minutes.
She denied any history of nosebleeds, trauma to the nose, or use of anticoagulant medications. 
The nursing team acted promptly, providing her with tissues and a basin while preparing to implement appropriate interventions for her condition.

Considering Emma Thompson's presentation with sudden, profuse epistaxis, what is the most appropriate nursing action for managing her condition?

A 45-year-old female with a known history of Addison's disease presents to the emergency department with complaints of severe fatigue, nausea, vomiting, and dizziness. She reports that she missed her morning dose of treatment due to ongoing gastrointestinal symptoms.
She appears dehydrated, with dry mucous membranes and poor skin turgor.  The nurse recognizes that the patient is experiencing an acute adrenal crisis and must initiate immediate treatment.

Which of the following is the most appropriate immediate intervention for this patient?

A 34-year-old male is brought to the emergency department after a motor vehicle accident.  The nurse is using the Glasgow Coma Scale to assess his level of consciousness.
Based on the patient’s presentation, what is his Glasgow Coma Scale (GCS) score?

A 45-year-old male is brought to the emergency department after sustaining burns in a house fire. He has partial-thickness burns covering the anterior chest, both arms, and his face. His vital signs are stable, but he reports severe pain.
The nurse is tasked with calculating the total body surface area (TBSA) affected to guide fluid resuscitation and further treatment.

Using the Rule of Nines, what percentage of this patient’s total body surface area (TBSA) is burned?

Alex, a 40-year-old man, is brought to the emergency department after being bitten by a venomous snake during a hike. He experiences localized pain, swelling, and discoloration around the bite site.

What is a crucial nursing implication in managing a patient like Alex who has been bitten by a venomous snake?

A 35-year-old male farmworker presents to the emergency department with excessive salivation, bradycardia (HR 48 bpm), miosis, and muscle twitching after being exposed to an organophosphate pesticide.
His vital signs are BP 110/70 mmHg, RR 18 breaths/min, and O2 saturation of 98%.

What is the most appropriate initial treatment for this patient?

A 54-year-old client was admitted to the emergency department with a significantly elevated blood alcohol concentration (BAC) of 0.24% (serum ethanol level of 240 mg/dL [52.1 mmol/L]). The client's history revealed a prolonged pattern of heavy alcohol use.

Given the high BAC and the client's history, the nurse prepared to closely monitor the client for specific symptoms that could indicate serious neurological or physiological disturbances.
These symptoms are critical to recognize promptly, as they can lead to severe, life-threatening conditions if left untreated.

Complete the following sentence by selecting from the lists of options below.

The priority nursing action is to monitor the client for and which are commonly associated with
  is useful in preventing Wernicke encephalopathy, an disorder due to deficiency manifested by confusion, ataxia, and ophthalmoplegia, as well as the chronic Korsakoff syndrome, which is manifested by memory impairment and amnesia.

In the aftermath of a large-scale natural disaster, the MetroCity General Hospital is inundated with casualties. Nurse leaders are called to a meeting to coordinate the response. They discuss leveraging their training in disaster management to ensure that the hospital responds efficiently and effectively.

Nurse leaders and their teams need to understand the guidelines and plan processes at local and regional levels. Clearly defined roles can prevent duplication of efforts and enhance coordination and orchestration of the all-hazards plan during an actual disaster. This will help allocate scarce resources and implement triage criteria for care in disaster events.

Which of the following two interventions reflects what is expected during disaster management?

Moments after a devastating tornado swept through a small town, Mercy General Hospital, situated a few miles from the epicenter, begins to witness an influx of victims. Dr. Carter, overseeing the ER, gathers his team for a brief huddle. The injuries range from minor scrapes to serious trauma cases. Amidst the chaos and limited resources, they need to prioritize their actions.

During the "Response" phase of disaster management, what should be the primary focus of the healthcare team?