Exam 1
1. A major portion of the construction project has collapsed. The emergency department
(ED) has been notified that numerous victims are being transported to the ED. What should
the first action of the ED nurse?
a) Assess department for resources - stuff, beds, equipment
b) Implement personnel recall system
c) Discharge stable clients
d) Set up a temporary morgue
2. An emergency room nurse assesses a patient who has been raped. With which healthcare
team member would the nurse collaborate when planning this patient’s care?
a) Emergency medicine physician
b) Case manager
c) Forensic nurse examiner
d) Psychiatric crisis nurse
3. An elderly patient who has fallen from a roof is transported to the emergency department by
ambulance. The patient was unconscious at the scene but is conscious on arrival and is
triaged as urgent. What is the priority assessment the nurse includes during the primary
survey of the patient?
a) A full set of vital signs
b) Cardiac rhythm
c) Neurological status
d) Patient history
4. The complex care provided during an emergency requires interdisciplinary collaboration.
Which interdisciplinary team members are paired with the correct responsibilities? SATA
a. Psychiatric crisis nurse-interacts with patients and families when sudden illness,
serious injury or death of a loved one may cause a crisis
b. Forensic nurse examiner - performs rapid assessments to ensure that patients with
the highest acuity receive the quickest evaluation, treatment, and prioritization of
resources
c. Triage nurse - provides basic life support interventions such as oxygen basic wound
care, splinting, spinal immobilization, and monitoring of vital signs
d. Emergency medical technician - obtains patient histories, collects evidence, and
offers counseling and follow up care for victims of rape, child abuse, and domestic
violence
e. Paramedic - provides prehospital advanced life support, including cardiac
monitoring, advanced airway management and medication administration
,5. An industrial site has experienced a radiation leak and workers who have been potentially
affected are en route to the hospital. To minimize the risks of contaminating the hospital,
managers should perform what action?
a) Place all potential victims on reverse isolation
b) Establish a triage outside the hospital
c) Have hospital staff put on personal protective equipment
d) Place hospital staff on abbreviated shifts of no more than 4 hours
6. A young man is brought to the emergency department as a victim of a multi vehicle
accident that caused multiple casualties. The man is awake and alert. He has a fracture of
his right tibia and several small lacerations on his face. How will the triage nurse
categorize this client?
a) Class I ( red tag)
b) Class II (Yellow tag)
c) Class III (Green Tag)
d) Class IV (Black Tag)
7. The nurse in the trauma unit has received a report on a client who has multiple injuries
following a motor vehicle crash. Which of the following actions should the nurse plan to
take first?
a) Evaluate the chest expansion
b) Check the pupillary response to light
c) Assess the capillary refill
d) Check clients response to questions about place and time
8. A nurse is teaching a group of clients about emergency care for a snake bite. Which of the
following information should the nurse include in the teaching?
a) Raise the affected extremity above the level of the heart
b) Immobilize the affected extremity with a splint
c) Apply ice to the bite area
d) Apply a tourniquet to the affected extremity
9. A man survived a workplace accident that claimed the lives of many of his colleagues
several months ago. The man has recently sought care for the treatment of depression.
How should the nurse best understand the man’s current mental health problem?
a) The man is experiencing a common response following a disaster
b) The man fails to appreciate the fact that he survived the disaster
c) The man most likely feels guilty about his actions during the disaster
d) The man’s depression most likely produced the disaster
10. How can nurses assist disaster victims to cope with their experience?
, a) Active listening
b) Referring to the hospital chaplin
c) Giving emotional outlet
d) Assisting to debrief
11. The spouse of a patient admitted with a gunshot wound asks the nurse when her husband
will be discharged so that they can resume their life together. With which of the following
should the nurse respond to this spouse?
a) Right now there is no way of knowing how soon your husband can return to his
previous life
b) I would say in a few weeks
c) Probably never
d) As soon as the wound heals your husband can return to work
12. During the primary assessment of a trauma victim, the nurse determines that the patient is
breathing and has an unobstructed airway. Which action should the nurse take next?
a) Observe the patient’s respiratory effort
b) Check the patient’s level of consciousness
c) Palpate extremities for capillary refill time
d) Examine the patient for any external bleeding
13. An emergency department nurse is transferring a client to the medical surgical unit. What
is the most important nursing intervention in this situation?
a) Triage the client to determine the urgency of care.
b) Clearly communicate client data to the unit nurse
c) Evaluate the need for ongoing medical treatment
d) Perform a thorough assessment of the client.
14. A nurse triages patients arriving at the hospital after a mass casualty. Which patients are
correctly classified? SATA
a) A 35 year old female with severe chest pain - red tag
b) A 42 year old male with full thickness body burn - green tag
c) A 55 year old female with a scalp laceration - black tag
d) A 60 year old male with an open fracture with distal pulses - yellow tag
e) An 88 year old male with shortness of breath and chest bruises - green tag
15. A patient is admitted with a thermal injury. The mechanism of injury that this patient
most likely experienced would be which of the following?
, a) Fire
b) Lightning
c) Ultraviolet radiation
d) Gunshot
16. While developing an emergency operations plan (EOP) the committee is discussing the
components of the EOP. During the pos-incident response of an emergency operations
plan, what activity will take place?
a) Deciding when the facility will go from disaster response to daily activities
b) Conducting practice drills for the community and facility
c) Conducting a critique and debriefing for all involved in the incident
d) Replacing the resources in the facility
17. A nurse is triaging clients in the emergency department. Which client complaining would
the triage nurse classify as non-urgent?
a) Chest pain and diaphoresis
b) Decreased breath sounds due to chest trauma
c) Left arm fracture with palpable radial pulses
d) Sore throat and temperature of 104 F
18. The emergency medical technicians (EMTs) arrive at the emergency department with an
unresponsive client with an oxygen mask in place. What will the nurse do first?
a) Assess the client is breathing adequately
b) Insert a large bore intravenous line
c) Place the client on a cardiac monitor
d) Assess for best neurologic response
19. The nurse is teaching a wilderness survival class. Which statement by a participant
indicates that additional teaching is needed?
a) If I get too cold, I can have some brandy to help me get warmed up
b) My climbing partner should let me know right away if my nose turns white
c) If my partner can’t think straight, we should descend to a lower altitude
d) It is okay to feel a little short of breath when I am climbing, but not at rest.
20. A community nurse assesses a client, who has an allergy to bees, after a bee sting. The
client’s lips are swollen, and wheezes are audible. What is the priority action of the nurse?
1. A major portion of the construction project has collapsed. The emergency department
(ED) has been notified that numerous victims are being transported to the ED. What should
the first action of the ED nurse?
a) Assess department for resources - stuff, beds, equipment
b) Implement personnel recall system
c) Discharge stable clients
d) Set up a temporary morgue
2. An emergency room nurse assesses a patient who has been raped. With which healthcare
team member would the nurse collaborate when planning this patient’s care?
a) Emergency medicine physician
b) Case manager
c) Forensic nurse examiner
d) Psychiatric crisis nurse
3. An elderly patient who has fallen from a roof is transported to the emergency department by
ambulance. The patient was unconscious at the scene but is conscious on arrival and is
triaged as urgent. What is the priority assessment the nurse includes during the primary
survey of the patient?
a) A full set of vital signs
b) Cardiac rhythm
c) Neurological status
d) Patient history
4. The complex care provided during an emergency requires interdisciplinary collaboration.
Which interdisciplinary team members are paired with the correct responsibilities? SATA
a. Psychiatric crisis nurse-interacts with patients and families when sudden illness,
serious injury or death of a loved one may cause a crisis
b. Forensic nurse examiner - performs rapid assessments to ensure that patients with
the highest acuity receive the quickest evaluation, treatment, and prioritization of
resources
c. Triage nurse - provides basic life support interventions such as oxygen basic wound
care, splinting, spinal immobilization, and monitoring of vital signs
d. Emergency medical technician - obtains patient histories, collects evidence, and
offers counseling and follow up care for victims of rape, child abuse, and domestic
violence
e. Paramedic - provides prehospital advanced life support, including cardiac
monitoring, advanced airway management and medication administration
,5. An industrial site has experienced a radiation leak and workers who have been potentially
affected are en route to the hospital. To minimize the risks of contaminating the hospital,
managers should perform what action?
a) Place all potential victims on reverse isolation
b) Establish a triage outside the hospital
c) Have hospital staff put on personal protective equipment
d) Place hospital staff on abbreviated shifts of no more than 4 hours
6. A young man is brought to the emergency department as a victim of a multi vehicle
accident that caused multiple casualties. The man is awake and alert. He has a fracture of
his right tibia and several small lacerations on his face. How will the triage nurse
categorize this client?
a) Class I ( red tag)
b) Class II (Yellow tag)
c) Class III (Green Tag)
d) Class IV (Black Tag)
7. The nurse in the trauma unit has received a report on a client who has multiple injuries
following a motor vehicle crash. Which of the following actions should the nurse plan to
take first?
a) Evaluate the chest expansion
b) Check the pupillary response to light
c) Assess the capillary refill
d) Check clients response to questions about place and time
8. A nurse is teaching a group of clients about emergency care for a snake bite. Which of the
following information should the nurse include in the teaching?
a) Raise the affected extremity above the level of the heart
b) Immobilize the affected extremity with a splint
c) Apply ice to the bite area
d) Apply a tourniquet to the affected extremity
9. A man survived a workplace accident that claimed the lives of many of his colleagues
several months ago. The man has recently sought care for the treatment of depression.
How should the nurse best understand the man’s current mental health problem?
a) The man is experiencing a common response following a disaster
b) The man fails to appreciate the fact that he survived the disaster
c) The man most likely feels guilty about his actions during the disaster
d) The man’s depression most likely produced the disaster
10. How can nurses assist disaster victims to cope with their experience?
, a) Active listening
b) Referring to the hospital chaplin
c) Giving emotional outlet
d) Assisting to debrief
11. The spouse of a patient admitted with a gunshot wound asks the nurse when her husband
will be discharged so that they can resume their life together. With which of the following
should the nurse respond to this spouse?
a) Right now there is no way of knowing how soon your husband can return to his
previous life
b) I would say in a few weeks
c) Probably never
d) As soon as the wound heals your husband can return to work
12. During the primary assessment of a trauma victim, the nurse determines that the patient is
breathing and has an unobstructed airway. Which action should the nurse take next?
a) Observe the patient’s respiratory effort
b) Check the patient’s level of consciousness
c) Palpate extremities for capillary refill time
d) Examine the patient for any external bleeding
13. An emergency department nurse is transferring a client to the medical surgical unit. What
is the most important nursing intervention in this situation?
a) Triage the client to determine the urgency of care.
b) Clearly communicate client data to the unit nurse
c) Evaluate the need for ongoing medical treatment
d) Perform a thorough assessment of the client.
14. A nurse triages patients arriving at the hospital after a mass casualty. Which patients are
correctly classified? SATA
a) A 35 year old female with severe chest pain - red tag
b) A 42 year old male with full thickness body burn - green tag
c) A 55 year old female with a scalp laceration - black tag
d) A 60 year old male with an open fracture with distal pulses - yellow tag
e) An 88 year old male with shortness of breath and chest bruises - green tag
15. A patient is admitted with a thermal injury. The mechanism of injury that this patient
most likely experienced would be which of the following?
, a) Fire
b) Lightning
c) Ultraviolet radiation
d) Gunshot
16. While developing an emergency operations plan (EOP) the committee is discussing the
components of the EOP. During the pos-incident response of an emergency operations
plan, what activity will take place?
a) Deciding when the facility will go from disaster response to daily activities
b) Conducting practice drills for the community and facility
c) Conducting a critique and debriefing for all involved in the incident
d) Replacing the resources in the facility
17. A nurse is triaging clients in the emergency department. Which client complaining would
the triage nurse classify as non-urgent?
a) Chest pain and diaphoresis
b) Decreased breath sounds due to chest trauma
c) Left arm fracture with palpable radial pulses
d) Sore throat and temperature of 104 F
18. The emergency medical technicians (EMTs) arrive at the emergency department with an
unresponsive client with an oxygen mask in place. What will the nurse do first?
a) Assess the client is breathing adequately
b) Insert a large bore intravenous line
c) Place the client on a cardiac monitor
d) Assess for best neurologic response
19. The nurse is teaching a wilderness survival class. Which statement by a participant
indicates that additional teaching is needed?
a) If I get too cold, I can have some brandy to help me get warmed up
b) My climbing partner should let me know right away if my nose turns white
c) If my partner can’t think straight, we should descend to a lower altitude
d) It is okay to feel a little short of breath when I am climbing, but not at rest.
20. A community nurse assesses a client, who has an allergy to bees, after a bee sting. The
client’s lips are swollen, and wheezes are audible. What is the priority action of the nurse?
