Disaster Nursing: Midterm Quiz & Lecture Notes PDF

DISASTER NURSING JOJEMAR G. ANERDIS, R.N., SCFHS-R.N., E.M.T. NURSE I/ MUNICIPAL DRRM-H MANAGER MUNICIPAL HEALTH OFFICE/RURAL HEALTH UNIT LGU CABATUAN c. Ventricular depolarization...

DISASTER NURSING JOJEMAR G. ANERDIS, R.N., SCFHS-R.N., E.M.T. NURSE I/ MUNICIPAL DRRM-H MANAGER MUNICIPAL HEALTH OFFICE/RURAL HEALTH UNIT LGU CABATUAN c. Ventricular depolarization NCM 121: LECTURE d. Atrial depolarization 6. The nurse should take note that pacemaker is used in some clients with dysrhythmia to serve MIDTERM QUIZ 1 the function that is normally performed by the: a. AV node 1. To which of the following nursing actions would b. Bundle of His a nurse give priority in the emergency care of a c. SA node patient who has sustained an open fracture of the d. Purkinje fibers femur? a. Splint the leg in its present position 7. During a cardiac arrest, the nurse and the b. Place the leg in neutral alignment arrest team must keep in mind the: c. Irrigate the wound with normal saline a. Age of the client d. Apply pressure directly over the wound b. Time of the client is anoxic c. Emergency medications available 2. A nurse would assess a patient who d. Heart rate of the client before the arrest experiences prolonged vomiting for signs of: a. hypovolemic shock. 8. The nurse should recognize that the most b. water intoxication. common cause of cardiac arrest in an adult is? c. metabolic acidosis. a. Electrolyte imbalance d. potassium excess. b. Respiratory arrest c. Ventricular fibrillation 3. When assessing a patient for hypovolemic d. Drug toxicity shock, which of the following data indicates that he is in IRREVERSIBLE stage of shock? 9. A clinical problem that can lead to the a. Restless, anxious and confused development of compartment syndrome is: b. Skin, cool, pale and moist a. circulatory compromise. c. Anuria b. improper alignment of a fracture. d. Pulse rapid and weak c. onset of an infection in the bone. d. muscle atrophy. 4. During the first 24 hours after thermal injury, the nurse should assess the client for what 10. When the nurse carried out the order of electrolyte imbalances? epinephrine, she expected which of the following a. Hypokalemia and hypernatremia drug actions to take effect on the patient? b. Hyperkalemia and hyponatremia a. Dilatation of the coronary arteries and c. Hypokalemia and hyponatremia increased myocardial perfusion. d. Hyperkalemia and hypernatremia b. Reduced peripheral vascular resistance and decreased oxygen need of the heart. 5. From an ECG reading, the nurse understands c. Relaxed smooth muscles affecting both that QRS complex represents : arterioles and veins. a. Ventricular repolarization d. Vasoconstriction and increased systemic blood b. End of ventricular depolarization pressure. PAGE 1 STARWIN B. PANES – BSN-4 – 09391009003  DISASTER NURSING JOJEMAR G. ANERDIS, R.N., SCFHS-R.N., E.M.T. NURSE I/ MUNICIPAL DRRM-H MANAGER MUNICIPAL HEALTH OFFICE/RURAL HEALTH UNIT LGU CABATUAN d. assess urine specific gravity. 11. In prioritizing the emergency management of a burn client, from highest to lowest priority, the MIDTERM QUIZ 2 nurse should arrange in what order? 1. Establish and maintain an airway. 1. The client sustained deep partial- and 2. Assess for associated injuries. full-thickness burns on the right anterior lower 3. Establish an IV line with large-gauge extremity and on the abdomen. Using the needle. Parkland formula, the nurse calculated that the 4. Remove the client from the burn source. client sustained how many percent of burns? a. 4,1,3,2 a. 18 % b. 4,2,1,3 b. 27 % c. 1,4,3,2 c. 13.5 % d. 1,2,4,3 d. 17% 12. The most effective way to extinguish the 2. What intravenous solution should the nurse flames with as little further damage as possible is prepare during fluid resuscitation of client with to: burns in the emergent phase? a. Remove the burning clothes. a. Plain NSS b. Slap the flames with his hands. b. D5 0.3 % NaCl c. Log roll on the grass/ground. c. 0.45% NaCl d. Pour cold liquid over the flames. d. Lactated Ringer’s solution 13. It is most important for the nurse to perform 3. Deep partial thickness burn is well understood which action once the flame has been by a nurse noting that? extinguished? a. Epidermis is only damaged. a. Assess the client's breathing. b. Epidermis and dermis are both damaged. b. Give the client a sip of water. c. Dermis is only damaged. c. Cover the client with a warm blanket. d. Structures beneath the skin are damaged. d. Calculate the extent of his burns. 4. The nurse understands that R in the protocol of 14. After checking the airway patency of client RACE during fire, stands for: RICE (Rescue, with burns, the nurse does which of the following? Alarm, Contain, Extinguish/Evacuate) a. Start an intravenous line. a. Respond b. Administer IV morphine. b. Run c. Anchor a Foley catheter. c. Rescue d. Obtain baseline laboratory studies. d. Rest Other: 15. The nurse anchors a Foley Catheter in a client with burns to: 5. A code red (fire) has been announced on the a. monitor for urinary tract infection. hospital unit. What is the nurse’s first response? b. prevent urine retention. a. Remove clients in danger from the fire. c. measure urine output accurately. b. Report the fire to other staff. PAGE STARWIN B. PANES – BSN-4 – 09391009003 2  DISASTER NURSING JOJEMAR G. ANERDIS, R.N., SCFHS-R.N., E.M.T. NURSE I/ MUNICIPAL DRRM-H MANAGER MUNICIPAL HEALTH OFFICE/RURAL HEALTH UNIT LGU CABATUAN c. Contain the fire. b. Metabolic acidosis d. Extinguish the fire c. Cerebral hypoxia d. Hypervolemia 6. Which of the following would you consider as the priority intervention in the emergency 11. Which assessment finding noted on the client management of client with chemical burns? by a nurse would early indicate that the client’s a. Maintain a patent airway. oxygenation status is compromised? b. Assess for associated injuries. a. The client is restless. c. Wash the chemical off with cool water. b. The client’s lips are cyanotic. d. Remove all clothing containing the chemical. c. The client’s heart rate is irregular. d. The client present cold clammy skin. 7. In a client sustained a chemical burn, the nurse top treatment priorities during the emergent 12. The pulse oximetry reading of client with phase of care includes: carbon monoxide poisoning is 100%. This a. Maintaining airway, breathing and circulation. suggests to the nurse that: b. Flushing his skin with cool water for an hour. a. There is no danger of hypoxia. c. Starting intravenous fluids. b. There is no carbon monoxide poisoning. It d. Obtaining laboratory works to assess should be ruled out. pulmonary status. c. This is not a reliable sign to rule out carbon Other: monoxide poisoning, further assessment is required. 8. What is the primary therapeutic goal during the d. That the client has an improved chance of acute phase of burns? surviving, since the client is well oxygenated. a. Wound healing b. Reconstructive surgery 13. Which of the following the nurse should do c. Emotional support first for client with sucking stab wound in the d. Fluid resuscitation chest wall? a. administer oxygen. 9. The best approach for preventing hypovolemic b. prepare to do tracheostomy. shock in a client with severe burns is to: c. prepare for endotracheal intubation. a. Administer dopamine. d. cover the wound with a petroleum-impregnated b. Apply medical anti shock trousers. dressing. c. Infuse IV fluids. d. Infuse fresh frozen plasma. 14. The nurse would know to administer the Heimlich maneuver on a suspected choking client 10. The client who sustained deep partial when the client: thickness and full thickness burns of face, whole a. becomes cyanotic. anterior chest and both upper extremities begins b. can make only minimal vocal noises. to exhibit extreme restlessness. You recognize c. cannot speak owing to airway obstruction. that this most likely indicates that the client is d. is coughing vigorously. developing: a. Renal failure PAGE STARWIN B. PANES – BSN-4 – 09391009003 3  DISASTER NURSING JOJEMAR G. ANERDIS, R.N., SCFHS-R.N., E.M.T. NURSE I/ MUNICIPAL DRRM-H MANAGER MUNICIPAL HEALTH OFFICE/RURAL HEALTH UNIT LGU CABATUAN 15. Which of the following assessments should analgesic during rewarming the nurse perform first when admitting the client to the nursing unit with C4 spinal cord injury? HEAT STROKE a. Take the temperature b. Assess extremity muscle strength - body temperature (>40C) c. Observe for spinal shock - reduce the high temperature ASAP d. Assessment of respiratory status remove clothing and sponging of cool water Other: ice application iced saline lavage, cooling blankets OTHER EMERGENCY CASES SNAKEBITES NEAR-DROWNING EXPERIENCE - lie down - remove constrictive items - a survival for at least 24 hrs - warm compress -hypoxemia - immobilize (dependent position) a. fresh water - atelectasis - monitor ABC b. saltwater - pulmonary edema - bring patient to the ER -hypothermia- most common - ice, tourniquet -heparin - contraindicated HYPOTHERMIA INSECT STING - core temperature of 30 mins E: 1. Idiopathic, CVA, fever 2. trauma - birth and head 3. brain tumor (glioma) 4. meningitis, encephalitis, abscess 5. hypoglycemia CORONARY ARTERY DISEASE (CAD) S/S : - a focal narrowing of coronary arteries due to - prodrome of uneasy feeling (aura) intimal plaque formation, which deprives the - loss of consciousness coronary blood flow. - convulsions, muscle twitching - excessive salivation Presentations : - stupor (post-ictal) 1. Angina Pectoris a. Stable angina NM : b. Unstable angina a. seizure precautions c. Prinzmetal's angina - elevate & pad all side rails 2. Myocardial Infarction - keep bed low position, pillow under the head 3. Sudden cardiac death - loosen clothing - standby suction machine/ 02 b. during seizure activity - don't restrain - don't put anything against a clenched teeth - record the duration/movements c. after seizure activity - side lying position - suction PRN & 02 - re-orient clients Manifestations : d. education - retrosternal chest pain typically described as - don't withdraw maintenance drugs (Dilantin) burning or squeezing that may radiate to the arm, w/o doctor's order jaw, neck and shoulder. PAGE STARWIN B. PANES – BSN-4 – 09391009003 6  DISASTER NURSING JOJEMAR G. ANERDIS, R.N., SCFHS-R.N., E.M.T. NURSE I/ MUNICIPAL DRRM-H MANAGER MUNICIPAL HEALTH OFFICE/RURAL HEALTH UNIT LGU CABATUAN - epigastric pain, restlessness, dyspnea - dizziness, syncope, cool, clammy skin S/S : - sudden, sharp, substernal or chest pain Dx: - DOB, tachycardia, restlessness, cyanosis and a a. Electrocardiogram sense of impending doom. Cardiac ischemia = T wave inversion Myocardial injury = ST elevation NM: Myocardial infarction = pathologic Q wave 1. Minimize the risk for DVT. 2. For sudden episodes of DOB ADULT RESPIRATORY DISTRESS - high back rest, SYNDROME (ARDS) - left side lying -Trendelenburg (Air) - 02 immediately - non-cardiogenic pulmonary edema - prepare for pulmonary angiography & - injury of the alveolar capillary membrane (shock V/Q scanning and sepsis) N=1 - white lung on CXR Dead space >1 Shunt < 1 S/S : 3. Prepare heparin - crackles/signs of respiratory distress - progressive hypoxemia PO2 (