Medical-surgical Emergencies Quiz

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1. In a multiple-trauma victim, which assessment finding signals the most serious and life-threatening condition? 

Explanation

A deviated trachea is a symptoms of tension pneumothorax. All of the other symptoms need to be addressed, but are of lesser priority.

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About This Quiz
Medical-surgical Emergencies Quiz - Quiz

This Medical-surgical Emergencies Quiz focuses on critical knowledge and response strategies related to medical-surgical emergencies. It covers recognition of common emergency conditions, appropriate interventions, and priority actions to stabilize patients. Topics include managing sudden complications during or after surgery, handling life-threatening situations such as shock, hemorrhage, respiratory distress, and cardiac... see morearrest.

The quiz aims to reinforce understanding of emergency protocols, assessment techniques, and quick decision-making skills essential in medical-surgical settings. Designed for healthcare professionals, it helps sharpen practical skills necessary for effective patient care during urgent situations. Test your readiness to respond confidently and efficiently in emergencies to improve patient safety and outcomes in surgical and medical environments. see less

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2. You are caring for a victim of frostbite to the feet. Place the following interventions in the correct order.  

a. Apply a loose, sterile, bulky dressing.  
b. Give pain medication.  
c. Remove the victim from the cold environment.  
d. Immerse the feet in warm water 100o F to 105o F (40.6o C to 46.1o C)  
_____, _____, _____, _____  
 

Explanation

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.

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3. You are working in the triage area of an ED, and four patients approach the triage desk at the same time. List the order in which you will assess these patients. 
a. An ambulatory, dazed 25-year-old male with a bandaged head wound  
b. An irritable infant with a fever, petechiae, and nuchal rigidity  
c. A 35-year-old jogger with a twisted ankle, having pedal pulse and no deformity  
d. A 50-year-old female with moderate abdominal pain and occasional vomiting  
_____, _____, _____, _____ 

Explanation

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.

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4. 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?  

a. Obtain an order for a chest x-ray to document tube placement.  
b. Secure the tube in place.  
c. Auscultate the chest during assisted ventilation.  
d. Confirm that the breath sounds are equal and bilateral.  
_____, _____, _____, _____  

Explanation

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.

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5. 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.  

a. Perform the chin lift or jaw thrust maneuver.  
b. Establish unresponsiveness.  
c. Initiate cardiopulmonary resuscitation (CPR).  
d. Call for help and activate the code team.  
e. Instruct a nursing assistant to get the crash cart.  
_____, _____, _____, _____, _____  

Explanation

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.

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6. 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  
_____, _____, _____, _____  

Explanation

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.

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7. When an unexpected death occurs in the ED, which of the following tasks is most appropriate to delegate to the nursing assistant? 

Explanation

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.

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8. 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?

Explanation

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.

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9. A teenager arrives by private car. He is alert and ambulatory, but this shirt and pants are covered with blood. He and his hysterical friends are yelling and trying to explain that that they were goofing around and he got poked in the abdomen with a stick. Which of the following comments should be given first 
consideration? 

Explanation

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.

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10. 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?

Explanation

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.

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11. The nursing manager decides to form a committee to address the issue of violence against ED personnel. Which combination of employees is best suited to 
fulfill this assignment? 

Explanation

At least one representative from each group should be included because all employees are potential targets fro violence in the ED.

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12. In the work setting, what is your primary responsibility in preparing for disaster management that includes natural disasters or bioterrorism incidents?

Explanation

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.

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13. 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? 

Explanation

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.

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14. 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?

Explanation

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.

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15. A 56-year-old patient presents in triage with left-sided chest pain, diaphoresis, and dizziness. This patient should be prioritized into which category?

Explanation

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).

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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?

Explanation

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 notsatisfied, the physician can give more information.

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17. It is the summer season, and patients with signs and symptoms of heat-related illness present in the ED. Which patient needs attention first?

Explanation

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 crams, 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.

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18. In conducting a primary survey on a trauma patient, which of the following is considered one of the priority elements of the primary survey?

Explanation

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.

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19. 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?

Explanation

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.

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20. 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? 

Explanation

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.

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21. A patient in a one-car rollover presents with multiple injuries. Prioritize the interventions that must be initiated for this patient.  

a. Secure/start two large-bore IVs with normal saline  
b. Use the chin lift or jaw thrust method to open the airway.  
c. Assess for spontaneous respirations  
d. Give supplemental oxygen per mask.  
e. Obtain a full set of vital signs.  
f. Remove patient’s clothing.  
g. Insert a Foley catheter if not contraindicated.  
_____, _____, _____, _____, ____, ____, ____ 

Explanation

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.

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22. 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? 

Explanation

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.

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23. A tearful parent brings a child to the ED for taking an unknown amount of children’s chewable vitamins at an unknown time. The child is currently alert and 
asymptomatic. What information should be immediately reported to the physician? 

Explanation

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.

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24. In caring for a victim of sexual assault, which task is most appropriate for an LPN/LVN?

Explanation

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.

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25. 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? 

Explanation

Safety is a priority for this patient, and she should not return to a place where violence could reoccur. The other options are important for the long term management of this care.

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26. A patient sustains an amputation of the first and second digits in a chainsaw accident. Which task should be delegated to the LPN/LVN?

Explanation

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.

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27. 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? 

Explanation

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.

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28. 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? 

Explanation

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.

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29. In relation to submersion injuries, which task is most appropriate to delegate to an LPN/LVN? 

Explanation

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.

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30. An intoxicated patient presents with slurred speech, mild confusion, and uncooperative behavior. The patient is a poor historian but admits to "drinking a few on the weekend." What is the priority nursing action for this patient? 

Explanation

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.

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In a multiple-trauma victim, which assessment finding signals the most...
You are caring for a victim of frostbite to the feet. Place the...
You are working in the triage area of an ED, and four patients...
Following emergency endotracheal intubation, you must verify tube...
You respond to a call for help from the ED waiting room. There is an...
These patients present to the ED complaining of acute abdominal pain....
When an unexpected death occurs in the ED, which of the following...
An experienced traveling nurse has been assigned to work in the ED;...
A teenager arrives by private car. He is alert and ambulatory, but...
You are assessing a patient who has sustained a cat bite to the left...
The nursing manager decides to form a committee to address the issue...
In the work setting, what is your primary responsibility in preparing...
A prisoner, with a known history of alcohol abuse, has been in police...
The physician has ordered cooling measures for a child with fever who...
A 56-year-old patient presents in triage with left-sided chest pain,...
You are preparing a child for IV conscious sedation prior to repair of...
It is the summer season, and patients with signs and symptoms of...
In conducting a primary survey on a trauma patient, which of the...
An anxious 24-year-old college student complains of tingling...
A 36-year-old patient with a history of seizures and medication...
A patient in a one-car rollover presents with multiple injuries....
The emergency medical service (EMS) has transported a patient with...
A tearful parent brings a child to the ED for taking an unknown amount...
In caring for a victim of sexual assault, which task is most...
You are giving discharge instructions to a woman who has been treated...
A patient sustains an amputation of the first and second digits in a...
You are assigned to telephone triage. A patient who was stung by a...
You are the charge nurse in an emergency department (ED) and must ...
In relation to submersion injuries, which task is most appropriate to...
An intoxicated patient presents with slurred speech, mild confusion,...
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