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Home Practice Test Medical-Surgical Nursing Exam 15: Emergency Nursing (30 Items)
PRACTICE TEST
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Take this 30-item examination that will review and challenge your knowledge about emergency nursing!
Feel the rush and raucousness (not guaranteed) of of the ER department in these questions that will
absolutely traumatize you.
Topics
Triage
Prioritization
Delegation
Disaster management
Guidelines
You are given one minute per question. Spend your time wisely!
Answers and rationales (if any) are given below. Be sure to read them.
If you need more clarifications, please direct them to the comments section.
Questions
EXAM MODE
PRACTICE MODE
TEXT MODE
In Text Mode: All questions and answers are given for reading and answering at your own pace. You can
also copy this exam and make a print out.
1. You are the charge nurse in an emergency department (ED) and must assign two staff members to
cover the triage area. Which team is the most appropriate for this assignment?
c. A 35-year-old jogger with a twisted ankle, having pedal pulse and no deformity
3. In conducting a primary survey on a trauma patient, which of the following is considered one of the
priority elements of the primary survey?
4. A 56-year-old patient presents in triage with left-sided chest pain, diaphoresis, and dizziness. This
patient should be prioritized into which category?
a. High urgent
b. Urgent
c. Non-urgent
d. Emergent
5. The physician has ordered cooling measures for a child with fever who is likely to be discharged when
the temperature comes down. Which of the following would be appropriate to delegate to the nursing
assistant?
6. It is the summer season, and patients with signs and symptoms of heat-related illness present in the
ED. Which patient needs attention first?
a. An elderly person complains of dizziness and syncope after standing in the sun for several hours to
view a parade
b. A marathon runner complains of severe leg cramps and nausea. Tachycardia, diaphoresis, pallor, and
weakness are observed.
c. A previously healthy homemaker reports broken air conditioner for days. Tachypnea, hypotension,
fatigue, and profuse diaphoresis are observed.
d. A homeless person, poor historian, presents with altered mental status, poor muscle coordination,
and hot, dry, ashen skin. Duration of exposure is unknown.
7. You respond to a call for help from the ED waiting room. There is an elderly patient lying on the floor.
List the order for the actions that you must perform.
b. Establish unresponsiveness.
8. The emergency medical service (EMS) has transported a patient with severe chest pain. As the patient
is being transferred to the emergency stretcher, you note unresponsiveness, cessation of breathing, and
no palpable pulse. Which task is appropriate to delegate to the nursing assistant?
a. Chest compressions
9. An anxious 24-year-old college student complains of tingling sensations, palpitations, and chest
tightness. Deep, rapid breathing and carpal spasms are noted. What priority nursing action should you
take?
10. An experienced traveling nurse has been assigned to work in the ED; however, this is the nurse’s first
week on the job. Which area of the ED is the most appropriate assignment for the nurse?
a. Trauma team
b. Triage
b. The child has been treated several times for ingestion of toxic substances.
c. The child has been treated several times for accidental injuries.
12. In caring for a victim of sexual assault, which task is most appropriate for an LPN/LVN?
13. You are caring for a victim of frostbite to the feet. Place the following interventions in the correct
order.
15. A 36-year-old patient with a history of seizures and medication compliance of phenytoin (Dilantin)
and carbamazepine (Tegretol) is brought to the ED by the MS personnel for repetitive seizure activity
that started 45 minutes prior to arrival. You anticipate that the physician will order which drug for status
epilepticus?
b. IV lorazepam (Ativan)
c. IV carbamazepine
d. IV magnesium sulfate
16. You are preparing a child for IV conscious sedation prior to repair of a facial laceration. What
information should you immediately report to the physician?
18. When an unexpected death occurs in the ED, which of the following tasks is most appropriate to
delegate to the nursing assistant?
19. Following emergency endotracheal intubation, you must verify tube placement and secure the tube.
List in order the steps that are required to perform this function?
b. “He pulled the stick out, just now, because it was hurting him.”
21. A prisoner, with a known history of alcohol abuse, has been in police custody for 48 hours. Initially,
anxiety, sweating, and tremors were noted. Now, disorientation, hallucination, and hyper-reactivity are
observed. The medical diagnosis is delirium tremens. What is the priority nursing diagnosis?
22. You are assigned to telephone triage. A patient who was stung by a common honey bee calls for
advice, reports pain and localized swelling, but denies any respiratory distress or other systemic signs of
anaphylaxis. What is the action that you should direct the caller to perform?
a. Call 911.
c. Remove wet clothing and cover the victim with a warm blanket.
24. You are assessing a patient who has sustained a cat bite to the left hand. The cat is up-to-date
immunizations. The date of the patient’s last tetanus shot is unknown. Which of the following is the
priority nursing diagnosis?
25. These patients present to the ED complaining of acute abdominal pain. Prioritize them in order of
severity.
a. A 35-year-old male complaining of severe, intermittent cramps with three episodes of watery
diarrhea, 2 hours after eating
b. A 11-year-old boy with a low-grade fever, left lower quadrant tenderness, nausea, and anorexia for the
past 2 days
c. A 40-year-old female with moderate left upper quadrant pain, vomiting small amounts of yellow bile,
and worsening symptoms over the past week
d. A 56-year-old male with a pulsating abdominal mass and sudden onset of pressure-like pain in the
abdomen and flank within the past hour
27. In a multiple-trauma victim, which assessment finding signals the most serious and life-threatening
condition?
a. A deviated trachea
d. Hematuria
28. A patient in a one-car rollover presents with multiple injuries. Prioritize the interventions that must
be initiated for this patient.
b. Use the chin lift or jaw thrust method to open the airway.
29. In the work setting, what is your primary responsibility in preparing for disaster management that
includes natural disasters or bioterrorism incidents?
30. You are giving discharge instructions to a woman who has been treated for contusions and bruises
sustained during an episode of domestic violence. What is your priority intervention for this patient?
b. Referral to a counselor
Below are the answers and rationale for the questions above. If you think the answers are wrong, please
comment below.
1. ANSWER C
Triage requires at least one experienced RN. Pairing an experienced RN with inexperienced RN provides
opportunities for mentoring. Advanced practice nurses are qualified to perform triage; however, their
services are usually required in other areas of the ED. An LPN/LVN is not qualified to perform the initial
patient assessment or decision making. Pairing an experienced RN with a nursing assistant is the second
best option, because the assistant can obtain vital signs and assist in transporting.
2. ANSWER B, A, D, C
An irritable infant with fever and petechiae should be further assessed for other meningeal signs. The
patient with the head wound needs additional history and assessment for intracranial pressure. The
patient with moderate abdominal pain is uncomfortable, but not unstable at this point. For the ankle
injury, medical evaluation can be delayed 24 – 48 hours if necessary.
3. ANSWER C
A brief neurologic assessment to determine level of consciousness and pupil reaction is part of the
primary survey. Vital signs, assessment of the abdomen, and initiation of pulse oximetry are considered
part of the secondary survey.
4. ANSWER D
Chest pain is considered an emergent priority, which is defined as potentially life-threatening. Patients
with urgent priority need treatment within 2 hours of triage (e.g. kidney stones). Non-urgent conditions
can wait for hours or even days. (High urgent is not commonly used; however, in 5-tier triage systems,
High urgent patients fall between emergent and urgent in terms of the time lapsing prior to treatment).
5. ANSWER A
The nursing assistant can assist with the removal of the outer clothing, which allows the heat to dissipate
from the child’s skin. Advising and explaining are teaching functions that are the responsibility of the RN.
Tepid baths are not usually performed because of potential for rebound and shivering.
6. ANSWER D
The homeless person has symptoms of heat stroke, a medical emergency, which increases risk for brain
damage. Elderly patients are at risk for heat syncope and should be educated to rest in cool area and
avoid future similar situations. The runner is having heat cramps, which can be managed with rest and
fluids. The housewife is experiencing heat exhaustion, and management includes fluids (IV or parenteral)
and cooling measures. The prognosis for recovery is good.
7. ANSWER B, D, A, C, E
Establish unresponsiveness first. (The patient may have fallen and sustained a minor injury.) If the
patient is unresponsive, get help and have someone initiate the code. Performing the chin lift or jaw
thrust maneuver opens the airway. The nurse is then responsible for starting CPR. CPR should not be
interrupted until the patient recovers or it is determined that heroic efforts have been exhausted. A
crash cart should be at the site when the code team arrives; however, basic CPR can be effectively
performed until the team arrives.
8. ANSWER A
Nursing assistants are trained in basic cardiac life support and can perform chest compressions. The use
of the bag-valve mask requires practice and usually a respiratory therapist will perform this function. The
nurse or the respiratory therapist should provide PRN assistance during intubation. The defibrillator pads
are clearly marked; however, placement should be done by the RN or physician because of the potential
for skin damage and electrical arcing.
9. ANSWER C
The patient is hyperventilating secondary to anxiety, and breathing into a paper bag will allow
rebreathing of carbon dioxide. Also, encouraging slow breathing will help. Other treatments such as
oxygen and medication may be needed if other causes are identified.
10. ANSWER C
The fast track clinic will deal with relatively stable patients. Triage, trauma, and pediatric medicine should
be staffed with experienced nurses who know the hospital routines and policies and can rapidly locate
equipment.
11. ANSWER A
Iron is a toxic substance that can lead to massive hemorrhage, coma, shock, and hepatic failure.
Deferoxame is an antidote that can be used for severe cases of iron poisoning. Other information needs
additional investigation, but will not change the immediate diagnostic testing or treatment plan.
12. ANSWER C
The LPN/LVN is able to listen and provide emotional support for her patients. The other tasks are the
responsibility of an RN or, if available, a SANE (sexual assault nurse examiner) who has received training
to assess, collect and safeguard evidence, and care for these victims.
13. ANSWER C, B, D, A
The victim should be removed from the cold environment first, and then the rewarming process can be
initiated. It will be painful, so give pain medication prior to immersing the feet in warmed water.
14. ANSWER C
The only correct intervention is C. the digits should be gently cleansed with normal saline, wrapped in
sterile gauze moistened with saline, and placed in a plastic bag or container. The container is then placed
on ice.
15. ANSWER B
IV Lorazepam (Ativan) is the drug of choice for status epilepticus. Tegretol is used in the management of
generalized tonic-clonic, absence or mixed type seizures, but it does not come in an IV form. PO (per os)
medications are inappropriate for this emergency situation. Magnesium sulfate is given to control
seizures in toxemia of pregnancy.
16. ANSWER C
Parent refusal is an absolute contraindication; therefore, the physician must be notified. Tetanus status
can be addressed later. The RN can restart the IV and provide information about conscious sedation; if
the parent still not satisfied, the physician can give more information.
17. ANSWER D
The patient presents with symptoms of alcohol abuse and there is a risk for Wernicke’s syndrome, which
is caused by a thiamine deficiency. Multiples drug abuse is not uncommon; however, there is nothing in
the question that suggests an opiate overdose that requires naloxone. Additional information or the
results of the blood alcohol level are part of the total treatment plan but should not delay the immediate
treatment.
18. ANSWER C
Postmortem care requires some turning, cleaning, lifting, etc., and the nursing assistant is able to assist
with these duties. The RN should take responsibility for the other tasks to help the family begin the
grieving process. In cases of questionable death, belongings may be retained for evidence, so the chain
of custody would have to be maintained.
19. ANSWER C, D, B, A
Auscultating and confirming equal bilateral breath sounds should be performed in rapid succession. If
the sounds are not equal or if the sounds are heard over the mid-epigastric area, tube placement must
be corrected immediately. Securing the tube is appropriate while waiting for the x-ray study.
20. ANSWER B
An impaled object may be providing a tamponade effect, and removal can precipitate sudden
hemodynamic decompensation. Additional history including a more definitive description of the blood
loss, depth of penetration, and medical history should be obtained. Other information, such as the dirt
on the stick or history of diabetes, is important in the overall treatment plan, but can be addressed later.
21. ANSWER A
The patient demonstrates neurologic hyperactivity and is on the verge of a seizure. Patient safety is the
priority. The patient needs chlordiazepoxide (Librium) to decrease neurologic irritability and phenytoin
(Dilantin) for seizures. Thiamine and haloperidol (Haldol) will also be ordered to address the other
problems. The other diagnoses are pertinent but not as immediate.
22. ANSWER B
The stinger will continue to release venom into the skin, so prompt removal of the stinger is advised.
Cool compresses and antihistamines can follow. The caller should be further advised about symptoms
that require 911 assistance.
23. ANSWER D
The asymptomatic patient is currently stable but should be observed for delayed pulmonary edema,
cerebral edema, or pneumonia. Teaching and care of critical patients is an RN responsibility. Removing
clothing can be delegated to a nursing assistant.
24. ANSWER A
Cat’s mouths contain a virulent organism, Pasteurella multocida, that can lead to septic arthritis or
bacteremia. There is also a risk for tendon damage due to deep puncture wounds. These wounds are
usually not sutured. A tetanus shot can be given before discharge.
25. ANSWER D, B, C, A
The patient with a pulsating mass has an abdominal aneurysm that may rupture and he may
decompensate suddenly. The 11-year-old boy needs evaluation to rule out appendicitis. The woman
needs evaluation for gallbladder problems that appear to be worsening. The 35-year-old man has food
poisoning, which is usually self-limiting.
26. ANSWER D
At least one representative from each group should be included because all employees are potential
targets fro violence in the ED.
27. ANSWER A
A deviated trachea is a symptoms of tension pneumothorax. All of the other symptoms need to be
addressed, but are of lesser priority.
28. ANSWER C, B, D, A, E, F, G
For a multiple trauma victim, many interventions will occur simultaneously as team members assist in
the resuscitation. Methods to open the airway such as the chin lift or jaw thrust can be used
simultaneously while assessing for spontaneous respirations. However, airway and oxygenation are
priority. Starting IVs for fluid resuscitation is part of supporting circulation. (EMS will usually establish at
least one IV in the field.) Nursing assistants can be directed to take vitals and remove clothing. Foley
catheter is necessary to closely monitor output.
29. ANSWER A
In preparing for disasters, the RN should be aware of the emergency response plan. The plan gives
guidance that includes roles of team members, responsibilities, and mechanisms of reporting. Signs and
symptoms of many agents will mimic common complaints, such as flu-like symptoms. Discussions with
colleagues and supervisors may help the individual nurse to sort through ethical dilemmas related to
potential danger to self.
30. ANSWER A
Safety is a priority for this patient, and she should not return to a place where violence could occur. The
other options are important for the long term management of this care.