Test Bank Forâ Medical-Surgical Nursing: Patient-Centered Collaborative Care (2 Volume Set), 8Th Edition, Donna D. Ignatavicius M. Linda Workman

Test Bank forÂ Medical-Surgical Nursing: Patient-Centered Collaborative Care (2 Volume Set),
Test Bank forÂ Medical-Surgical Nursing:

Patient-Centered Collaborative Care (2 Volume Set),
8th Edition, Donna D. Ignatavicius M. Linda Workman
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Chapter 9: Care of Patients with Common Environmental Emergencies
Ignatavicius: Medical-Surgical Nursing, 8th Edition
MULTIPLE CHOICE
1. On a hot humid day, an emergency department nurse is caring for a client who is confused
and has these vital signs: temperature 104.1° F (40.1° C), pulse 132 beats/min, respirations
26 breaths/min, blood pressure 106/66 mm Hg. Which action should the nurse take?
a. Encourage the client to drink cool water or sports drinks.
b. Start an intravenous line and infuse 0.9% saline solution.
c. Administer acetaminophen (Tylenol) 650 mg orally.
d. Encourage rest and re-assess in 15 minutes.
ANS: B
The client demonstrates signs of heat stroke. This is a medical emergency and priority care
includes oxygen therapy, IV infusion with 0.9% saline solution, insertion of a urinary
catheter, and aggressive interventions to cool the client, including external cooling and
internal cooling methods. Oral hydration would not be appropriate for a client who has
symptoms of heat stroke because oral fluids would not provide necessary rapid rehydration,
and the confused client would be at risk for aspiration. Acetaminophen would not decrease
this client’s temperature or improve the client’s symptoms. The client needs immediate
medical treatment; therefore, rest and re-assessing in 15 minutes is inappropriate.
DIF: Applying/Application REF: 121

KEY: Heat-related illness| environmental emergencies
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation
2. While at a public park, a nurse encounters a person immediately after a bee sting. The
person’s lips are swollen, and wheezes are audible. Which action should the nurse take first?
a. Elevate the site and notify the person’s next of kin.
b. Remove the stinger with tweezers and encourage rest.
c. Administer diphenhydramine (Benadryl) and apply ice.
d. Administer an EpiPen from the first aid kit and call 911.
ANS: D
The client’s swollen lips indicate that anaphylaxis may be developing, and this is a medical
emergency. 911 should be called immediately, and the client transported to the emergency
department as quickly as possible. If an EpiPen is available, it should be administered at the
first sign of an anaphylactic reaction. The other answers do not provide adequate
interventions to treat airway obstruction due to anaphylaxis.

KEY: Bee and insect sting| anaphylaxis| environmental emergencies
3. A client presents to the emergency department after prolonged exposure to the cold. The
client is difficult to arouse and speech is incoherent. Which action should the nurse take
first?
a. Reposition the client into a prone position.
b. Administer warmed intravenous fluids to the client.
c. Wrap the client’s extremities in warm blankets.
d. Initiate extracorporeal rewarming via hemodialysis.
ANS: B
Moderate hypothermia manifests with muscle weakness, increased loss of coordination,
acute confusion, apathy, incoherence, stupor, and impaired clotting. Moderate hypothermia
should be treated by core rewarming methods, which include administration of warm IV
fluids, heated oxygen, and heated peritoneal, pleural, gastric, or bladder lavage, and by
positioning the client in a supine position to prevent orthostatic changes. The client’s trunk
should be warmed prior to the extremities to prevent peripheral vasodilation. Extracorporeal
warming with cardiopulmonary bypass or hemodialysis is a treatment for severe
hypothermia.

KEY: Cold-related illness| environmental emergencies
4. An emergency department nurse cares for a middle-aged mountain climber who is confused
and exhibits bizarre behaviors. After administering oxygen, which priority intervention
should the nurse implement?
a. Administer dexamethasone (Decadron).
b. Complete a mini–mental state examination.
c. Prepare the client for computed tomography of the brain.
d. Request a psychiatric consult.
ANS: A
The client is exhibiting signs of mountain sickness and high altitude cerebral edema
(HACE). Dexamethasone (Decadron) reduces cerebral edema by acting as an
anti-inflammatory in the central nervous system. The other interventions will not treat
mountain sickness or HACE.

KEY: Altitude-related illness| environmental emergencies
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies
5. An emergency department nurse assesses a client admitted after a lightning strike. Which
assessment should the nurse complete first?
a. Electrocardiogram (ECG)
b. Wound inspection
c. Creatinine kinase
d. Computed tomography of head
ANS: A
Clients who survive an immediate lightning strike can have serious myocardial injury,
which can be manifested by ECG and myocardial perfusion abnormalities. The nurse should
prioritize the ECG. Other assessments should be completed but are not the priority.

KEY: Lightning injuries| environmental emergencies
MSC: Integrated Process: Nursing Process: Assessment
6. A nurse teaches a community health class about water safety. Which statement by a
participant indicates that additional teaching is needed?
a. “I can go swimming all by myself because I am a certified lifeguard.”
b. “I cannot leave my toddler alone in the bathtub for even a minute.”
c. “I will appoint one adult to supervise the pool at all times during a party.”
d. “I will make sure that there is a phone near my pool in case of an emergency.”
ANS: A
People should never swim alone, regardless of lifeguard status. The other statements
indicate good understanding of the teaching.
DIF: Analyzing/Analysis REF: 135

KEY: Drowning| environmental emergencies
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection
Control
7. A provider prescribes a rewarming bath for a client who presents with partial-thickness
frostbite. Which action should the nurse take prior to starting this treatment?
a. Administer intravenous morphine.
b. Wrap the limb with a compression dressing.
c. Massage the frostbitten areas.
d. Assess the limb for compartment syndrome.
ANS: A
Rapid rewarming in a water bath is recommended for all instances of partial-thickness and
full-thickness frostbite. Clients experience severe pain during the rewarming process and
nurses should administer intravenous analgesics.

8. A nurse assesses a client recently bitten by a coral snake. Which assessment should the
nurse complete first?
a. Unilateral peripheral swelling
b. Clotting times
c. Cardiopulmonary status
d. Electrocardiogram rhythm
ANS: C
Manifestations of coral snake envenomation are the result of its neurotoxic properties. The
physiologic effect is to block neurotransmission, which produces ascending paralysis,
reduced perception of pain, and, ultimately, respiratory paralysis. The nurse should monitor
for respiratory rate and depth. Severe swelling and clotting problems do not occur with coral
snakes but do occur with pit viper snakes. Electrocardiogram rhythm is not affected by
neurotoxins.

KEY: Snakebite| environmental emergencies
9. A nurse plans care for a client admitted with a snakebite to the right leg. With whom should
the nurse collaborate?
a. The facility’s neurologist
b. The poison control center
c. The physical therapy department
d. A herpetologist (snake specialist)
ANS: B
For the client with a snakebite, the nurse should contact the regional poison control center
immediately for specific advice on antivenom administration and client management.
DIF: Remembering/Knowledge REF: 124

KEY: Snakebite| poison control| environmental emergencies
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
10. While on a camping trip, a nurse cares for an adult client who had a drowning incident in a
lake and is experiencing agonal breathing with a palpable pulse. Which action should the
nurse take first?
a. Deliver rescue breaths.
b. Wrap the client in dry blankets.
c. Assess for signs of bleeding.
d. Check for a carotid pulse.
ANS: A
In this emergency situation, the nurse should immediately initiate airway clearance and
ventilator support measures, including delivering rescue breaths.

KEY: Drowning| environmental emergencies
11. A nurse assesses a client admitted with a brown recluse spider bite. Which priority
assessment should the nurse perform to identify complications of this bite?
a. Ask the client about pruritus at the bite site.
b. Inspect the bite site for a bluish purple vesicle.
c. Assess the extremity for redness and swelling.
d. Monitor the client’s temperature every 4 hours.
ANS: D
Fever and chills indicate systemic toxicity, which can lead to hemolytic reactions, kidney
failure, pulmonary edema, cardiovascular collapse, and death. Assessing for a fever should
be the nurse’s priority. All other symptoms are normal for a brown recluse bite and should
be assessed, but they do not provide information about complications from the bite, and
therefore are not the priority.

KEY: Spider bite| environmental emergencies
12. A provider prescribes Crotalidae Polyvalent Immune Fab (CroFab) for a client who is
admitted after being bitten by a pit viper snake. Which assessment should the nurse
complete prior to administering this medication?
a. Assess temperature and for signs of fever.
b. Check the client’s creatinine kinase level.
c. Ask about allergies to pineapple or papaya.
d. Inspect the skin for signs of urticaria (hives).
ANS: C
CroFab is an antivenom for pit viper snakebites. Clients should be assessed for
hypersensitivity to bromelain (a pineapple derivative), papaya, and sheep protein prior to
administration. During and after administration, the nurse should assess for urticaria, fever,
and joint pain, which are signs of serum sickness.
DIF: Understanding/Comprehension REF: 125

KEY: Antivenom| snakebite| environmental emergencies
Therapies
13. A provider prescribes diazepam (Valium) to a client who was bitten by a black widow
spider. The client asks, “What is this medication for?” How should the nurse respond?
a. “This medication is an antivenom for this type of bite.”
b. “It will relieve your muscle rigidity and spasms.”
c. “It prevents respiratory difficulty from excessive secretions.”
d. “This medication will prevent respiratory failure.”
ANS: B
Black widow spider venom produces a syndrome known as latrodectism, which manifests as
severe abdominal pain, muscle rigidity and spasm, hypertension, and nausea and vomiting.
Diazepam is a muscle relaxant that can relieve pain related to muscle rigidity and spasms. It
does not prevent respiratory difficulty or failure.

KEY: Benzodiazepine| spider bite| environmental emergencies
Therapies
14. After teaching a client how to prevent altitude-related illnesses, a nurse assesses the client’s
understanding. Which statement indicates the client needs additional teaching?
a. “If my climbing partner can’t think straight, we should descend to a lower
altitude.”
b. “I will ask my provider about medications to help prevent acute mountain
sickness.”
c. “My partner and I will plan to sleep at a higher elevation to acclimate more
quickly.”
d. “I will drink plenty of fluids to stay hydrated while on the mountain.”
ANS: C
Teaching to prevent altitude-related illness should include descending when symptoms start,
staying hydrated, and taking acetazolamide (Diamox), which is commonly used to prevent
and treat acute mountain sickness. The client should be taught to sleep at a lower elevation.

KEY: Altitude-related illness| environmental emergencies
NOT: Client Needs Category: Health Promotion and Maintenance
MULTIPLE RESPONSE
1. A nurse is teaching a wilderness survival class. Which statements should the nurse include
about the prevention of hypothermia and frostbite? (Select all that apply.)
a. “Wear synthetic clothing instead of cotton to keep your skin dry.”
b. “Drink plenty of fluids. Brandy can be used to keep your body warm.”
c. “Remove your hat when exercising to prevent the loss of heat.”
d. “Wear sunglasses to protect skin and eyes from harmful rays.”
e. “Know your physical limits. Come in out of the cold when limits are reached.”
ANS: A, D, E
To prevent hypothermia and frostbite, the nurse should teach clients to wear synthetic
clothing (which moves moisture away from the body and dries quickly), layer clothing, and
wear a hat, facemask, sunscreen, and sunglasses. The client should also be taught to drink
plenty of fluids, but to avoid alcohol when participating in winter activities. Clients should
know their physical limits and come in out of the cold when these limits have been reached.

2. A nurse teaches a client who has severe allergies to prevent bug bites. Which statements
should the nurse include in this client’s teaching? (Select all that apply.)
a. “Consult an exterminator to control bugs in and around your home.”
b. “Do not swat at insects or wasps.”
c. “Wear sandals whenever you go outside.”
d. “Keep your prescribed epinephrine auto-injector in a bedside drawer.”
e. “Use screens in your windows and doors to prevent flying insects from entering.”
ANS: A, B, E
To prevent arthropod bites and stings, clients should wear protective clothing, cover garbage
cans, use screens in windows and doors, inspect clothing and shoes before putting them on,
consult an exterminator, remove nests, avoid swatting at insects, and carry a prescription
epinephrine auto-injector at all times if they are known to be allergic to bee or wasp stings.

KEY: Bee and insect sting| environmental emergencies
3. A nurse is providing health education at a community center. Which instructions should the
nurse include in teaching about prevention of lightning injuries during a storm? (Select all
that apply.)
a. Seek shelter inside a building or vehicle.
b. Hide under a tall tree.
c. Do not take a bath or shower.
d. Turn off the television.
e. Remove all body piercings.
f. Put down golf clubs or gardening tools.
ANS: A, C, D, F
When thunder is heard, shelter should be sought in a safe area such as a building or an
enclosed vehicle. Electrical equipment such as TVs and stereos should be turned off. Stay
away from plumbing, water, and metal objects. Do not stand under an isolated tall tree or a
structure such as a flagpole. Body piercings will not increase a person’s chances of being
struck by lightning.

KEY: Lightning injuries| environmental emergencies
4. An emergency department nurse moves to a new city where heat-related illnesses are
common. Which clients does the nurse anticipate being at higher risk for heat-related
illnesses? (Select all that apply.)
a. Homeless individuals
b. Illicit drug users
c. White people
d. Hockey players
e. Older adults
ANS: A, B, E
Test Bank forÂ Medical-Surgical Nursing: Patient-Centered Collaborative Care (2 Volume Set),
Some of the most vulnerable, at-risk populations for heat-related illness include older adults;
blacks (more than whites); people who work outside, such as construction and agricultural
workers (more men than women); homeless people; illicit drug users (especially cocaine
users); outdoor athletes (recreational and professional); and members of the military who are
stationed in countries with hot climates (e.g., Iraq, Afghanistan).

NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
5. An emergency department nurse plans care for a client who is admitted with heat stroke.
Which interventions should the nurse include in this client’s plan of care? (Select all that
apply.)
a. Administer oxygen via mask or nasal cannula.
b. Administer ibuprofen, an antipyretic medication.
c. Apply cooling techniques until core body temperature is less than 101° F.
d. Infuse 0.9% sodium chloride via a large-bore intravenous cannula.
e. Obtain baseline serum electrolytes and cardiac enzymes.
ANS: A, D, E
Heat stroke is a medical emergency. Oxygen therapy and intravenous fluids should be
provided, and baseline laboratory tests should be performed as quickly as possible. The
client should be cooled until core body temperature is reduced to 102° F. Antipyretics
should not be administered.
DIF: Understanding/Comprehension REF: 123

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To download the complete and accurate content document, go to:

Visit TestBankBell.com to get complete for all chapters

DIF: Applying/Application REF: 121

DIF: Applying/Application REF: 129

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DIF: Applying/Application REF: 134

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DIF: Analyzing/Analysis REF: 135

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DIF: Remembering/Knowledge REF: 124

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DIF: Understanding/Comprehension REF: 125

DIF: Applying/Application REF: 127

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DIF: Applying/Application REF: 126

DIF: Remembering/Knowledge REF: 130

DIF: Remembering/Knowledge REF: 120

DIF: Understanding/Comprehension REF: 123

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