First Aid, Emergency Care, and Disaster Management

MULTIPLE CHOICE

1. A maintenance man falls from a ladder into the unit hall, striking his head on some
equipment. The man is unconscious and not breathing; the Code Team has already been
paged and is on its way. The nurse should:
1. wait for the team to start CPR.
2. open airway with a jaw thrust.
3. give two rescue breaths after extending the neck.
4. start chest compressions.
ANS: 2
The jaw thrust, rather than neck extension, is used when a head or neck injury is suspected.
CPR should be initiated and then taken over by the Code Team when they arrive.

2. Standing in a fast food line, the person in front, while munching on a cookie, begins to
cough heavily, with deep inspirations, and waves his arms around wildly. The nurse should
immediately:
1. start rescue breathing as quickly as possible.
2. start chest compressions as quickly as possible.
3. perform the Heimlich maneuver.
4. do nothing at this point as long as there is air exchange.
ANS: 4
When a person chokes, if he or she is alert enough to be attempting to cough and force the
obstruction up and out by themselves, it is best to let them do it alone, because there is more
expelling force that way. Only if the person is showing signs of not being able to breathe
beyond the obstruction should the Heimlich maneuver be applied.

3. One-person CPR principles, as taught and practiced by professional nurses, require that the
initial intervention for an unconscious patient who is not breathing is to:
1. lift the jaw to clear the airway.
2. call for assistance.
3. start chest compressions.
4. make two rescue breaths.
ANS: 2
With one-person CPR, when the patient is unconscious and not breathing, the first thing to
do is to call for help.

4. The nurse assesses that the patient is in shock based on the findings of:
1. lack of urine output in the last hour, thready pulse, shallow respirations, decreased
BP, and patient crying softly.
2. failure of the neurological system, thready pulse, decreased respirations, decreased
BP, and decreased LOC.
3. failure of the renal system with bounding pulse, shallow respirations, decreased
BP, 300 mL urine in the last hour, displaying unfounded anger.
 4. unable to arouse patient, temperature 99.2º F, pulse 100, respiration 30, BP 120/78.
ANS: 1
Shock is failure of the circulatory system, producing altered vital signs, as listed.

5. The nurse comes upon a traffic accident. One passenger is lying on the ground by an open
door. The nurse stops and begins immediate nursing interventions by proceeding with
assessing:
1. for uncontrolled bleeding.
2. ABC: airway, breathing, and circulation.
3. for abdominal deep wounds.
4. level of LOC and orientation.
ANS: 2
The ABC method of emergency assessment reminds the caregiver to check the essentials
first.

6. The nurse finds a patient slumped to the floor and unconscious, with no pulse or respiration.
The nurse should begin the protocol of:
1. basic life support.
2. advanced life support.
3. cardiopulmonary resuscitation.
4. first aid care.
ANS: 1
Basic life support is the first level of care in keeping the brain oxygenated.

7. As an immediate treatment for epistaxis, the nurse should give the following instructions:
1. “Stand still, lean your head backward so that the blood won’t get all over
everything, and pinch your nose shut for at least 10 minutes.”
2. “Stand still, lean your head forward, and pinch your nose tightly for at least 10
minutes.”
3. “Sit down on a solid surface, lean your head forward to let the blood run out, and
then pinch your nose closed for at least 30 minutes.”
4. “Sit down on a solid surface, lean your head forward so that you don’t choke on
the blood, and pinch your nose shut for at least 10 minutes.”
ANS: 4
Blood from a nosebleed in the anterior portion of the nasal cavity will usually stop with
pinch pressure within 10 minutes. Blood from a nosebleed should not be swallowed.

8. Which condition complicates the assessment of an older adult patient with a suspected head
injury?
1. Sensory deficits
2. Slowed metabolism
3. Preexisting cerebral dysfunction
4. Decreased pulmonary function
ANS: 1
Sensory deficits, circulatory disorders, and communication problems make it more difficult
to assess an older adult patient with a suspected head injury.
 9. The nurse is called on to assist a neighbor who needs first aid. The nurse knows that legal
responsibility for this action would be that the nurse:
1. is legally bound to help in any way possible.
2. is expected to demonstrate the same skill, knowledge, and care that would be
provided by other nurses in the same community with the same credentials.
3. has no legal responsibilities outside the hospital setting and would be held
accountable for nothing.
4. can legally perform any aid skill, even those not allowed the nurse in the hospital.
ANS: 2
U.S. laws protect nurses when they act in the same manner as others licensed at their level
would do in the same circumstances.

10. A nurse comes upon a traffic accident where there are injured, unconscious people lying on
the highway. The nurse is aware that first aid interventions are sanctioned by the:
1. Good Samaritan Act.
2. Emergency Care Doctrine.
3. Fifth Amendment.
4. Liability Protection Against Malpractice Act.
ANS: 1
Most states have Good Samaritan Acts, which protect voluntary caregivers from malpractice
claims.

11. The nurse giving discharge instructions to the patient who is severely allergic to insect stings
would caution the patient to:
1. wear bright colors to repel insects.
2. apply perfume liberally as a protection.
3. dress in sleeveless, easily removable garments.
4. obtain an emergency treatment kit.
ANS: 4
An emergency kit with Benadryl and/or injectable epinephrine is recommended. Insects are
attracted by bright colors and perfume. Arms and legs should be covered with clothing.

12. The patient is admitted to the emergency room after having been bitten on the hand by a
black widow spider. The nursing intervention that is indicated is to:
1. monitor for respiratory distress.
2. wrap the hand in a warm compress.
3. seat the patient upright in a chair.
4. elevate the patient’s hand above his or her heart.
ANS: 1
Neurotoxins frequently cause anaphylaxis, with severe respiratory distress and seizure.
Therefore, the patient should be protected from falls and the hand be kept cool and below
the heart to delay spread of the toxin.

13. The nurse can cease CPR when there is:

1. spontaneous breathing and absence of dyspnea.
2. spontaneous breathing and absence of cyanosis.
 3. heartbeat and spontaneous breathing.
4. heartbeat and return of consciousness.
ANS: 3
Cardiopulmonary resuscitation success refers to the lack of need for assisted respiration and
assisted blood circulation. These two criteria are met when the heartbeat and spontaneous
breathing are restored.

14. When the accident victim presents to the emergency room with an open sucking chest
wound, the nurse should apply to the wound:
1. occlusive dressing taped on four sides.
2. tight Ace bandage wrap.
3. no dressing of any sort.
4. flutter dressing taped on three sides.
ANS: 4
A flutter dressing taped on three sides allows no more air to enter the pleural space, but
allows the expanding lung to push air out. A four-sided dressing allows the trapped air to
remain and possibly collapse the lung.

15. A homeless person is brought to the ER after having been found asleep on a park bench
under a layer of snow. He has a rectal temperature of 97 F. The nurse anticipates which of
the following additional symptoms?
1. Diminished breath sounds, inadequate chest expansion
2. Shivering, decreased heart rate, and increased blood pressure
3. Confusion, increased hunger, hypertension
4. Decreased irregular heart and respiratory rates, decreased blood pressure
ANS: 4
The hypothermic client will continue to chill as vital signs deteriorate.

16. A mother brings in her 2-year-old who has drunk gasoline 1 hour ago. After initial
assessment, the nurse will:
1. prepare to administer syrup of ipecac.
2. turn patient on the stomach to induce vomiting.
3. prepare to administer milk of magnesia.
4. prepare to administer bowel lavage and cathartics.
ANS: 4
Bowel lavage and cathartics will rid the body of the petroleum product. Inducing vomiting
when the patient has consumed petroleum products is contraindicated. Ipecac is no longer
recommended and milk of magnesia will not be effective.

17. While at the local pool on an extremely hot day, the nurse is called on to care for a woman
who has evidently suffered heat exhaustion. The initial nursing care for this person is to:
1. obtain vital signs.
2. move the patient into an air-conditioned or shaded area.
3. give her several glasses of ice water.
4. cover her with a wet towel.
ANS: 2
 The goal for treatment of heat exhaustion is initially to cool the body slowly in an air-
conditioned or shaded area. Once the patient is moved, application of wet towels and giving
cool drinks are appropriate.

18. The patient presents in the ER with an evisceration following a knife attack. The best
nursing intervention related to the exposed bowel is to:
1. gently replace the bowel into the abdominal cavity.
2. place a sterile wrapped sandbag on the abdomen to prevent further evisceration.
3. place the patient in a high Fowler’s position to allow the bowel to drop back into
the abdominal cavity.
4. cover the bowel with a moist saline dressing.
ANS: 4
The nurse protects the tissue from further injury and drying out by the application of a
sterile saline dressing.

19. The patient presents to the industrial nurse after an accident on the factory floor, which
amputated three toes. Effective nursing intervention for the amputated toes would be:
1. rinsing with normal saline and placing on a sterile towel.
2. placing toes as they are on ice in a sterile container.
3. placing the unwrapped toes in a saline bath.
4. placing the saline-wrapped toes in a plastic bag in a saline bath.
ANS: 4
The toes should be wrapped in saline dressing and placed in an airtight bag in a cool saline
bath. The toes should not be in direct contact with ice or be placed in the freezer.

20. Six hours after a beach picnic on a hot afternoon, a young man enters the ER with nausea
and vomiting, headache, and diarrhea. On interview, the patient says that he ate potato salad
and tuna fish sandwiches. The nurse anticipates that the causative organism for these
symptoms is:
1. Clostridium botulinum
2. Clostridium perfringens
3. Salmonella
4. Staphylococcus aureus
ANS: 4
Staphylococcus aureus incubates in undercooked foods, especially eggs and mayonnaise,
and can cause GI symptoms as little as 6 hours later.

21. When the child is brought to the ER with several deep dog bites on his legs, the nurse will,
after cleaning the wounds, be primarily concerned with ascertaining the:
1. whereabouts of the dog.
2. status of tetanus inoculation.
3. rabies status of the animal.
4. child’s allergy to rabies vaccine.
ANS: 2
 Tetanus prophylaxis should be confirmed so that it can be brought up to date, if necessary.
The whereabouts of the dog will be the responsibility of the proper authorities, who will also
observe it for rabies. Inoculation for rabies is not an immediate concern unless the bites
were on the head or face and can be delayed until the dog is found to be rabid or not.

22. A barely conscious patient is brought to the ER with the handle of a nail file sticking part
way out of the right side of the chest. The nurse’s actions initially should be to:
1. turn the patient to the left side and prepare to remove the nail file.
2. place a pillow under the right side and elevate the head.
3. notify the charge nurse to call the hospital administration.
4. stabilize the nail file with a dressing and turn the patient to the right side.
ANS: 4
Stabilizing the nail file is essential to prevent further damage, because it should not be
removed. Turning the patient to the right side will aid in the respiratory effort of the left
lung. There is no need to call the hospital administration and the police have already been
notified by the EMS.

23. A visitor cuts herself badly on the arm and is bleeding profusely. The nurse’s immediate
treatment for this condition is to:
1. call any doctor and send the visitor immediately to the ER.
2. apply direct pressure to the arm with sterile dressing.
3. take the visitor’s blood pressure and pulse.
4. immobilize the injured arm and send the visitor immediately to the ER.
ANS: 2
The first actions should be to stop the blood flow, protect the wound from infection, and call
for more help.

24. A young man is noticed staggering out of a partially closed doorway to a garage, where a car
is running inside. He speaks slowly in a very low voice, telling the nurse that he fell asleep
in the car with the engine running. The immediate nursing diagnosis and action for this
nurse is:
1. impaired gas exchange. Have the person lie down flat right where he is and begin
rescue breathing. If the nurse sees anyone, call for help with CPR.
2. impaired gas exchange resulting from inhalation of carbon monoxide. Lead the
patient away from the garage and call for help. Stay with the patient and
continually assess LOC and respirations.
3. impaired circulatory perfusion resulting from sulfur dioxide poisoning. Have the
patient lie down flat, keep the patient still, and call for help.
4. impaired gas exchange. Have the man breathe deeply and continuously into a
brown paper bag. Assess pulse, respirations, and color of conjunctiva. Check the
man’s pockets for a cell phone to call 911.
ANS: 2
The man is still conscious enough to speak, although slowly, and therefore does not yet need
CPR. Fumes from the garage are entering the air around them. There is a need to get the
nurse and the man away from the fumes. The man may at any time lose consciousness;
sitting down would prevent a fall, so the nurse should call for help. Staying reassures the
patient and lessens his or her anxiety response.
25. On the initial assessment of a patient with carbon dioxide poisoning, the ER nurse would
anticipate that:
1. the blood pressure will be low.
2. oxygen saturation will be low.
3. the mucous membranes will be blue.
4. respirations will be less than 10 per minute.
ANS: 2
CO2 binds to the hemoglobin more readily than O2, causing hypoxemia. The mucous
membranes will be cherry red and the BP will be elevated because of hypoxia.