Chapter - 084 Emergency Department

Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive
Outcomes, 7th Edition
Chapter 84: Management of Clients in the Emergency Department
MULTIPLE CHOICE
1. An unconscious client is brought to the emergency department (ED) by ambulance following

a car accident. Without a family member to give informed consent, the nurse should
a. wait until a family member is contacted before treating the client.
b. have a hospital administrator sign the consent form.
c. begin treatment of the client without informed consent.
d. request the physician to sign the consent form.
ANS: c
When a client is unable to give consent or is unconscious, emergency treatment can be provided
under the emergency doctrine. This doctrine assumes that the client would consent to treatment
to prevent death or disability if the client were so able.
DIF: Cognitive Level: Knowledge REF: Text Reference: 2481

TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
2. The nurse must notify the state health department when a client comes to the ED with
a. influenza.
b. meningitis.
c. scarlet fever.
d. encephalitis.
ANS: b
Certain communicable disorders, such as hepatitis, sexually transmitted diseases, chickenpox,
measles, mumps, meningitis, tuberculosis, and food poisoning are reported to the state health
department.
DIF: Cognitive Level: Application REF: Text Reference: 2482

3. The ED triage nurse identifies the client who can have treatment delayed for a few hours as
the client with a
a. black eye from having been hit by a baseball.
b. large laceration that needs suturing.
c. broken finger.
d. head injury from a fall.
ANS: a
Chapter 84: Management of Clients in the Emergency Department 2
The client requires treatment, but life/limb/vision is not threatened if care cannot be provided
within 1 to 2 hours.
DIF: Cognitive Level: Analysis REF: Text Reference: 2484, Box 84-3;
TOP: Nursing Process Step: Assessment
4. The nurse triaging clients in an ED assigns a woman who is brought to the department
complaining of severe chest pain the priority category of
a. emergency.
b. urgent.
c. nonurgent.
d. vital.
ANS: a
In the emergency category, the client must be treated immediately, otherwise life/limb/vision is
threatened.
DIF: Cognitive Level: Application REF: Text Reference: 2484, Box 84-3;
5. When a client is admitted to the ED with respiratory distress and rapid-sequence induction
(RSI) is needed to intubate the client, the nurse should first
a. establish intravenous (IV) access.
b. insert a nasogastric tube.
c. apply nasal oxygen.
d. hyperventilate with 50% oxygen.
ANS: a
RSI involves (1) establishing venous access; (2) hyperventilating the client with 100% oxygen,
(3) administering an IV general barbiturate or anesthetic medication.

6. After stabilizing a trauma victim's airway, breathing, and circulation, the next item for the ED
nurse to assess is
a. neurologic status.
b. broken bones.
c. abdomen.
d. gastrointestinal status.
ANS: a
Elsevier items and derived items © 2005 by Elsevier Inc.

Once it is determined that the client's airway, breathing, and circulation (ABC) status is
satisfactory, the secondary assessment is performed to identify any other non–life-threatening
problems the client may be experiencing. The secondary assessment includes the following
elements: neurologic assessment, history, pain, general overview, and focused assessment.

7. A client has died from very disfiguring injuries received in an automobile accident. When the
family arrives moments later, the nurse relays the news to the family and then should
a. tell the family that it is best not to view the body.
b. give the full details of the extent of the fatal injuries.
c. allow the family to be alone to grieve.
d. help the family to focus on decisions requiring immediate attention.
ANS: d
When death occurs, the ED nurse and physician have important roles in informing the family:
provide the family with an explanation of the course of events related to the death; offer the
family an opportunity to view the body if desired; help the family focus on decisions requiring
immediate attention; and provide community agency referral as needed.

MSC: NCLEX: Psychosocial Integrity
8. A young man is admitted to the ED after sustaining a gunshot wound and dies within a short
time. In order to prepare the body prior to the family’s viewing it, the nurse should
a. remove all tubes and instruments used in treatment.
b. wash the body thoroughly.
c. remove all clothing in order to give it to the family.
d. wrap all clothing already removed and place it in a paper bag.
ANS: d
Tips for preserving evidence in the ED: minimally handle the body of a deceased person; place
wet clothing in individual paper bags (do not use plastic bags, as wet clothes can "sweat,"
thereby destroying evidence); and collect the client's personal items.
DIF: Cognitive Level: Application REF: Text Reference: 2483, Box 84-1;
MSC: NCLEX: Safe, Effective Care Environment;
9. A client is brought to the ED with a suspected neck injury. The nurse should
a. place a rolled towel under the client’s neck.
b. apply a hard cervical collar to the nuchal area.
c. adjust the table to sit the client upright.
d. check for full range of motion of the head.

ANS: b
When there is a suspected neck injury the head should be manually stabilized. Apply a hard
cervical collar, place on a spinal board, and place immobilizing devices to head and neck.

10. When a client's respiratory rate drops to 10 breaths per minute, and oxygen saturation
readings have fallen to 84%, the nurse should deliver oxygen via
a. high-flow oxygen via a bag-valve-mask device.
b. low-flow oxygen via nasal prongs.
c. high-flow oxygen via a partial rebreather mask.
d. low-flow oxygen via a nonrebreather mask.
ANS: a
Administering high-flow oxygen via a bag-valve-mask device is often required to reduce the
systemic hypoxemia and to return oxygen levels to between 80 and 100 mm Hg.

11. A client with a chest injury develops respiratory distress, distended jugular neck veins, and
tracheal deviation. The nurse concludes that these manifestations are consistent with
a. hemothorax.
b. flail chest.
c. adult respiratory distress syndrome.
d. tension pneumothorax.
ANS: d
A tension pneumothorax produces the clinical manifestations of extreme respiratory distress,
distended jugular neck veins, and a mediastinal shift of the heart, trachea, esophagus, and great
vessels on the side away from the tension pneumothorax.
DIF: Cognitive Level: Analysis REF: Text Reference: 2492

12. The nurse administering crystalloid fluid replacement to an adult client who has experienced
severe fluid volume deficit informs the client that for every liter of estimated fluid loss, he
will receive a resuscitation of
a. 1 L.
b. 2 L.
c. 3 L.
d. 5 L.
ANS: c

Crystalloid fluids (normal saline, lactated Ringer's solution) are the replacement fluids of choice.
They should be warmed and administered at a ratio of 3:1 (3 L of solution for every 1 L of
volume loss) in the adult.
DIF: Cognitive Level: Knowledge REF: Text Reference: 2495

13. The nurse is caring for a client who sustained a burn injury and is receiving fluid
resuscitation. If the total fluid volume replacement over a 24-hour period is 6 L, the nurse
should expect to administer how much fluid during the first 8 hours of the 24-hour period
post burn?
a. 3 L
b. 2 L
c. 1.5 L
d. 1 L
ANS: c
One half of the total fluid amount is infused in the first 8-hour period, one fourth of the fluid
amount in the second 8-hour period, and the remaining one fourth in the last 8-hour period.

14. A client admitted to the ED exhibits raccoon's eyes and Battle's sign. The nurse interprets that
these manifestations are compatible with
a. basilar skull fracture.
b. opiate overdose or poisoning.
c. extreme fatigue and sensory deprivation.
d. subarachnoid hemorrhage.
ANS: a
Bruising of the face, eyes (raccoon's eyes), or mastoid process (Battle's sign) or a bluish hue to
the tympanic membrane can indicate a recent head injury and an associated basilar skull fracture.

15. A nurse is preparing to administer 150 mg of intravenous phenytoin to a client with seizure
activity. After diluting the medication with the supplied diluent, the nurse will infuse the
medication over a period of
a. 1 minute.
b. 2 minutes.
c. 3 minutes.
d. 4 minutes.

ANS: c
Phenytoin must be diluted and infused at a rate of less than 50 mg/minute.

16. When a client is brought to the ED with chemical injury to the left eye, the nurse would
irrigate the eye with normal saline, a minimum of
a. 250 cc.
b. 500 cc.
c. 1000 cc.
d. 2000 cc.
ANS: c
For exposure to harmful chemicals, the eye must be irrigated with a minimum of 1 L of normal
saline.

17. The nurse is caring for a client brought to the ED after suffering amputation of a toe. The
nurse should take care to avoid
a. cleansing the stump area with normal saline.
b. placing the toe directly on ice.
c. wrapping the toe in sterile gauze moistened with saline.
d. placing the wrapped toe in a plastic bag.
ANS: b
The stump is cleansed with normal saline. The amputated part is wrapped in sterile gauze
moistened with normal saline. It is then placed in a plastic bag or container, and the plastic bag
or container is placed on ice. The amputated part should never be placed directly on ice because
freezing of the tissues will result.

18. The nurse explains to the family of a client with a spinal cord injury that IV
methylprednisolone will reduce
a. pain.
b. possibility of seizure.
c. muscle spasms.
d. spinal cord edema.
ANS: d

Administration of high-dose IV steroids such as methylprednisolone may be considered to

reduce cord edema.

19. The nurse clarifies that the law specifies that an ED client cannot be transferred to another
facility until the client is stable. “Stable” is interpreted to mean that the client
a. has a blood pressure of at least 90/50.
b. is not likely to deteriorate during transfer.
c. is conscious and able to provide necessary information.
d. has been evaluated by a physician.
ANS: b
“Stable” means that the client’s condition will not deteriorate during the transfer to another
facility.

20. A teenage girl brings her newborn baby wrapped in a bloody T-shirt into the ED and says she
intends to leave the baby there. The nurse should
a. restrain the mother.
b. notify social services.
c. call the police.
d. initiate admission to the pediatric unit.
ANS: b
People may voluntarily abandon newborns in the care of an ED, which will notify social
services, who will take the child into their custody.
DIF: Cognitive Level: Analysis REF: Text Reference: 2484

MSC: NCLEX: Psychosocial Integrity

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Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive

Outcomes, 7th Edition

Chapter 84: Management of Clients in the Emergency Department

1. An unconscious client is brought to the emergency department (ED) by ambulance following

DIF: Cognitive Level: Knowledge REF: Text Reference: 2481

DIF: Cognitive Level: Application REF: Text Reference: 2482

DIF: Cognitive Level: Application REF: Text Reference: 2489

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 2485

DIF: Cognitive Level: Application REF: Text Reference: 2484

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 2490

DIF: Cognitive Level: Application REF: Text Reference: 2491

DIF: Cognitive Level: Analysis REF: Text Reference: 2492

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Knowledge REF: Text Reference: 2495

DIF: Cognitive Level: Application REF: Text Reference: 2496

DIF: Cognitive Level: Application REF: Text Reference: 2498

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 2499

DIF: Cognitive Level: Application REF: Text Reference: 2500

DIF: Cognitive Level: Application REF: Text Reference: 2502

Elsevier items and derived items © 2005 by Elsevier Inc.

Administration of high-dose IV steroids such as methylprednisolone may be considered to

DIF: Cognitive Level: Application REF: Text Reference: 2502

DIF: Cognitive Level: Application REF: Text Reference: 2481

DIF: Cognitive Level: Analysis REF: Text Reference: 2484

Elsevier items and derived items © 2005 by Elsevier Inc.

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