MDC4 Final Exam
Study online at https://quizlet.com/_hpfnnt
1. What does triaging do?: *acts as gatekeeper*
helps prioritize patient care based on illness and severity level
2. According to triage, what patients would be seen firtst: highest acuity patients will receive
quickest intervention
(Most ill/severe will get seen first)
3. What is a good model for triaging patients?: ABCs
4. Is hospital triaging the same as mass casualty triaging?: NO
5. Which triage situation uses tags?: mass casualties
6. what are the categories of triage?: - emergent
- urgent
- nonurgent
- primary survey
7. what classifies a patient as emergent according to triage: - life threatening injuries
- needs immediate treatment
8. what patient conditions warrant an emergent status of triage: - respiratory distress
- chest pain with diaphoresis
- stroke
- active hemorrhage
- unstable vitals
9. what classifies a patient as urgent according to triage: patient should be treated quickly
but there is not and immediate threat to life
10. what patient conditions warrant an urgent status for triage: - severe abdominal pain
- renal colic
- displaced multiple fractures
- new onset of respiratory infection (pneumonia)
11. what classifies a patient as nonurgent according to triage: patient can wait several
hours without a risk to life
12. what patient conditions warrant a nonurgent status for triage: - skin rash
- strains/sprains
- colds
- simple fracture
, MDC4 Final Exam
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13. what is a primary survey that should be performed while triaging?: ABCDE
14. what does ABCDE stand for in triaging patients: A: Airway/cervical spine
B: Breathing
C: Circulation
D: Disability
E: Exposure
15. what does the "A" refer to in ABCDE: airway, cervical spine
- patent airway
- immobilize spine
**do NOT move patient
16. what does the "B" refer to in ABCDE: breathing
- assess sounds
- assess chest wall movement
17. what does the "C" refer to in ABCDE: circulation
- vitals (BP and pulse)
- maintain vascular access
- stop any bleeding
18. what does the "D" refer to in ABCDE: disability
*LOC
19. what does the "E" refer to in ABCDE: exposure
- get clothes off
- use blankets to prevent hypothermia
20. what is the one exception to ABCDE?: in excessive bleeding, you would prioritize "C" before "AB"
21. what is a secondary survey?: comprehensive head to toe assessment
22. if warranted during the secondary survey, what would a nurse likely do?: -
insert NG tube
- insert catheter
- prep for diagnostics
, MDC4 Final Exam
Study online at https://quizlet.com/_hpfnnt
23. what does drowning lead to?: leads to loss of surfactant in lungs which causes alveolar collapse and
pulmonary edema
24. is dehydration common in heat exhaustion?: YES
25. what can major diaphoresis cause?: severe dehydration and hyponatremia
26. if heat exhaustion goes untreated, what can it cause?: heat stroke
27. what are the s/s of heat exhaustion: -dehydration
-decrease in blood volume
-decrease in BP
-tachycardia
28. what is the first intervention for a person expected to have heat exhaustion?-
: stop their physical activity and transfer to a cool place
29. what is the quickest way to reduce someone's temperature?: - remove clothing
- remove bed linen
30. what interventions are there for cooling patients down?: - cold pack on the neck, chest,
abdomen, and groin
- soak in cool water
31. when rehydrating someone with heat exhaustion, should you use water or
a sports drink/oral reydration solution?: Sports drink/oral hydration solution
32. why is a sports drink better at rehydrating patients with heat exhaustion?: -
plain water can worsen sodium deficits
33. nursing care for patients hospitalized with heat exhaustion: - monitor vitals
- administer .9% NS in N/V is present
- draw labs to check electrolytes
34. how is heat stroke defined?: body temperature greater than 104F
35. T/F: heat stroke is a medical emergency: TRUE
36. T/F: if heat stroke is left untreated it becomes fatal: TRUE
37. s/s of heat stroke: - tachycardia
- hallucinations
- irregular pulse
- decreased urin output
- hot and dry skin
Study online at https://quizlet.com/_hpfnnt
1. What does triaging do?: *acts as gatekeeper*
helps prioritize patient care based on illness and severity level
2. According to triage, what patients would be seen firtst: highest acuity patients will receive
quickest intervention
(Most ill/severe will get seen first)
3. What is a good model for triaging patients?: ABCs
4. Is hospital triaging the same as mass casualty triaging?: NO
5. Which triage situation uses tags?: mass casualties
6. what are the categories of triage?: - emergent
- urgent
- nonurgent
- primary survey
7. what classifies a patient as emergent according to triage: - life threatening injuries
- needs immediate treatment
8. what patient conditions warrant an emergent status of triage: - respiratory distress
- chest pain with diaphoresis
- stroke
- active hemorrhage
- unstable vitals
9. what classifies a patient as urgent according to triage: patient should be treated quickly
but there is not and immediate threat to life
10. what patient conditions warrant an urgent status for triage: - severe abdominal pain
- renal colic
- displaced multiple fractures
- new onset of respiratory infection (pneumonia)
11. what classifies a patient as nonurgent according to triage: patient can wait several
hours without a risk to life
12. what patient conditions warrant a nonurgent status for triage: - skin rash
- strains/sprains
- colds
- simple fracture
, MDC4 Final Exam
Study online at https://quizlet.com/_hpfnnt
13. what is a primary survey that should be performed while triaging?: ABCDE
14. what does ABCDE stand for in triaging patients: A: Airway/cervical spine
B: Breathing
C: Circulation
D: Disability
E: Exposure
15. what does the "A" refer to in ABCDE: airway, cervical spine
- patent airway
- immobilize spine
**do NOT move patient
16. what does the "B" refer to in ABCDE: breathing
- assess sounds
- assess chest wall movement
17. what does the "C" refer to in ABCDE: circulation
- vitals (BP and pulse)
- maintain vascular access
- stop any bleeding
18. what does the "D" refer to in ABCDE: disability
*LOC
19. what does the "E" refer to in ABCDE: exposure
- get clothes off
- use blankets to prevent hypothermia
20. what is the one exception to ABCDE?: in excessive bleeding, you would prioritize "C" before "AB"
21. what is a secondary survey?: comprehensive head to toe assessment
22. if warranted during the secondary survey, what would a nurse likely do?: -
insert NG tube
- insert catheter
- prep for diagnostics
, MDC4 Final Exam
Study online at https://quizlet.com/_hpfnnt
23. what does drowning lead to?: leads to loss of surfactant in lungs which causes alveolar collapse and
pulmonary edema
24. is dehydration common in heat exhaustion?: YES
25. what can major diaphoresis cause?: severe dehydration and hyponatremia
26. if heat exhaustion goes untreated, what can it cause?: heat stroke
27. what are the s/s of heat exhaustion: -dehydration
-decrease in blood volume
-decrease in BP
-tachycardia
28. what is the first intervention for a person expected to have heat exhaustion?-
: stop their physical activity and transfer to a cool place
29. what is the quickest way to reduce someone's temperature?: - remove clothing
- remove bed linen
30. what interventions are there for cooling patients down?: - cold pack on the neck, chest,
abdomen, and groin
- soak in cool water
31. when rehydrating someone with heat exhaustion, should you use water or
a sports drink/oral reydration solution?: Sports drink/oral hydration solution
32. why is a sports drink better at rehydrating patients with heat exhaustion?: -
plain water can worsen sodium deficits
33. nursing care for patients hospitalized with heat exhaustion: - monitor vitals
- administer .9% NS in N/V is present
- draw labs to check electrolytes
34. how is heat stroke defined?: body temperature greater than 104F
35. T/F: heat stroke is a medical emergency: TRUE
36. T/F: if heat stroke is left untreated it becomes fatal: TRUE
37. s/s of heat stroke: - tachycardia
- hallucinations
- irregular pulse
- decreased urin output
- hot and dry skin
