HLTENN037/HLTENN038 Nursing care & clinical
skills/ax. - Week 3 (Nursing assessment &
management of deteriorating pt's) Exam Questions
and Correct Answer
1.........................................................................early response correct answer: An
e...r... to an emergency is the first step in resp.......................What happens next may be
determined
by the following factors that will help the nurse recognise the at-risk or deteriorating individual correct
answer:
• Intuition correct answer: 'gut feelings' tell you to observe, look closer and ask questions • Knowing
the individual correct answer: ensure that you read the history and the previous shift notes and
perform a baseline assessment of the individual
• Pattern recognition correct answer: look at the graphical charts and look for subtle changes in trends
• Physiological changes correct answer: in most instances these occur gradually.
2....................emergency correct answer: is a situation requiring immediate action.
3. optimal outcomes correct answer: ...pt. = early recognition + rapid response
. Failure to identify and interpret signs and symptoms of clinical deterioration and to initiate early
interventions can mean clients don't receive appropriate and timely treatment
. Serious adverse outcomes such as unplanned transfer to intensive care and cardiopulmonary arrest can
result.
4. EN correct answer: Related to recognising deteriorating pts
When working in any setting it is imperative that the can recognise and be prepared for an emergency
situation.
Some simple ways you can do this includes
5. prep correct answer: >Make time to plan & p...
-Know the emergency number in the facility and how to get help when you need it
-Know where the resuscitation trolley is located
,-Know the contents of the resuscitation trolley and where to find replacement items
-At the start of every shift check oxygen and suction are in working order behind each of your patient's
bed
-Understand your role in an emergency situation
-Keep up-to-date with your resuscitation skills and assessment skills
-Be involved and pro-active
6. emergency care aim correct answer: Purpose/a. is correct answer:
-To preserve life
-To promote recovery
-To relieve pain
, -To protect the unconscious patient
-To prevent further deterioration
7. MET/code blue correct answer: Internal phone MHS Brisbane correct answer: Dial 555 MPHR
only correct answer: Dial 666
State the following correct answer:
• Code Blue or medical emergency team call
• Hospital (e.g. Mater Hospital Brisbane)
• Location and bed number (e.g. Ward 8A, bed 826)
• Type of client (e.g. adult client)
• Your name and the number you are calling from
• The patient's treating team
-The medical emergency response team will respond to calls immediately, to arrive at the destination within
10 minutes.
-The MET/Code Blue call will take precedence over all other duties except other life-threatening emergencies
occurring elsewhere
8. 1st responder correct answer: aka. you as the EN/SEN
- Stay with the patient and call for local assistance by correct answer:
a. Activating the
bedside emergency buzzer; and
b. Initiating appropriate emergency care.
Process/role (related to DRSABCD)
1. Assess area for D-anger
2. Check the pt for a R-esponse
3. If pt is unresponsive, S-end/call for assistance & press the emergency buzzer for help
4. Assess the A-irway, clear any obstructions & perform an airway-opening manoeuvre
5. Check for normal B-reathing. If unresponsibve & not breathing normally, commense C-PR w 30
chest compressions & 2 breaths
skills/ax. - Week 3 (Nursing assessment &
management of deteriorating pt's) Exam Questions
and Correct Answer
1.........................................................................early response correct answer: An
e...r... to an emergency is the first step in resp.......................What happens next may be
determined
by the following factors that will help the nurse recognise the at-risk or deteriorating individual correct
answer:
• Intuition correct answer: 'gut feelings' tell you to observe, look closer and ask questions • Knowing
the individual correct answer: ensure that you read the history and the previous shift notes and
perform a baseline assessment of the individual
• Pattern recognition correct answer: look at the graphical charts and look for subtle changes in trends
• Physiological changes correct answer: in most instances these occur gradually.
2....................emergency correct answer: is a situation requiring immediate action.
3. optimal outcomes correct answer: ...pt. = early recognition + rapid response
. Failure to identify and interpret signs and symptoms of clinical deterioration and to initiate early
interventions can mean clients don't receive appropriate and timely treatment
. Serious adverse outcomes such as unplanned transfer to intensive care and cardiopulmonary arrest can
result.
4. EN correct answer: Related to recognising deteriorating pts
When working in any setting it is imperative that the can recognise and be prepared for an emergency
situation.
Some simple ways you can do this includes
5. prep correct answer: >Make time to plan & p...
-Know the emergency number in the facility and how to get help when you need it
-Know where the resuscitation trolley is located
,-Know the contents of the resuscitation trolley and where to find replacement items
-At the start of every shift check oxygen and suction are in working order behind each of your patient's
bed
-Understand your role in an emergency situation
-Keep up-to-date with your resuscitation skills and assessment skills
-Be involved and pro-active
6. emergency care aim correct answer: Purpose/a. is correct answer:
-To preserve life
-To promote recovery
-To relieve pain
, -To protect the unconscious patient
-To prevent further deterioration
7. MET/code blue correct answer: Internal phone MHS Brisbane correct answer: Dial 555 MPHR
only correct answer: Dial 666
State the following correct answer:
• Code Blue or medical emergency team call
• Hospital (e.g. Mater Hospital Brisbane)
• Location and bed number (e.g. Ward 8A, bed 826)
• Type of client (e.g. adult client)
• Your name and the number you are calling from
• The patient's treating team
-The medical emergency response team will respond to calls immediately, to arrive at the destination within
10 minutes.
-The MET/Code Blue call will take precedence over all other duties except other life-threatening emergencies
occurring elsewhere
8. 1st responder correct answer: aka. you as the EN/SEN
- Stay with the patient and call for local assistance by correct answer:
a. Activating the
bedside emergency buzzer; and
b. Initiating appropriate emergency care.
Process/role (related to DRSABCD)
1. Assess area for D-anger
2. Check the pt for a R-esponse
3. If pt is unresponsive, S-end/call for assistance & press the emergency buzzer for help
4. Assess the A-irway, clear any obstructions & perform an airway-opening manoeuvre
5. Check for normal B-reathing. If unresponsibve & not breathing normally, commense C-PR w 30
chest compressions & 2 breaths
