Med-Surg 3 Questions PDF

1. The penetrating head wound burns over 60% of the body, agonal respirations, no BP, pupils fixed and dilated. - Black Tag 2. Sucking chest wound, shock, hemothorax, asphyxia, incomplete amputations, open fractures - Red Tag 3. Stable abdominal wounds, soft tissue injurie...

1. The penetrating head wound burns over 60% of the body, agonal respirations, no BP, pupils fixed and dilated. - Black Tag 2. Sucking chest wound, shock, hemothorax, asphyxia, incomplete amputations, open fractures - Red Tag 3. Stable abdominal wounds, soft tissue injuries, maxillofacial wounds w/o airway compromise - Yellow tag 4. Upper extremity fractures, minor burns, sprains, behavioral disorders - Green Tag 5. The person was involved but has no apparent injuries. - Involved/White Tag 6. Healthcare providers should be prepared and respond by reporting which to the CDC? - Increase in certain disease in a normally healthy population 7. S/sx of \_\_\_\_\_ are dyspnea, hypoxia, tachypnea, apnea, cough, chest pain, hemodynamic instability - Blast Lung 8. Most frequent injury from a pressure wave with s/s of hearing loss, tinnitus, pain, dizziness, and otorrhea is? - tympanic membrane rupture 9. Head injury is most common cause post-blast deaths that's usually caused by falling debris or blast itself - True 10. When does the mediastinum start hemorrhaging? Is it a hallmark sign? - Anthrax; yes 11. Which one incubates in 12 days? - Smallpox 12. Probable survivors for acute radiation syndrome have no initial symptoms or only minimal (n/v) - True 13. when helping a pt post-disaster, you should encourage them to return to normal activities - True 14. Components of Critical Incident Stress Management (CISM): - Education, Field support, Defusing, Debriefing, Demobilization, Follow-up 15. A pt w/ an open abdominal injury is in the ER, which order would the nurse question? - Force oral Fluids 16. The ER triage nurse has 4 pts to assess for a multiple car crash. Which pt assessment should take priority? - A pt w/ unequal pupils - a pt w/ ecchymosis in the flank area - a pt w/ tachycardia - **a pt w/ deviated trachea** 17. pt complains of being very thirsty and wants something to drink. Which response by the nurse is appropriate? - until we determine if you need surgery, you aren\'t allowed anything 18. A pt comes to the ER w/ open abdominal wounds following an MVA. the pt is confused so what is the priority? - Stop the bleeding and start NS 19. Pt arrives @ ER that has sustained a human bite to the left hand. pts last tetanus is unknown. Which is Priority dx? - risk for infection r/t organisms to human bite 20. a pt w/ difficulty maintaining an airway d/t hemorrhage in the oral cavity. What is nursing dx? - ineffective airway clearance 21. Botulism and anthrax can not be disseminated - False 22. What is the initial step of medical personnel @ the scene of a disaster? - Triaging 23. Which of the following is not a symptom of nerve gas exposure? - Constipation 24. When decontamination begins, which of the following actions is a priority? - double bag all waste - collect all water used in decontamination - Cover the floor - Not Open air duct 25. Symptoms of nerve gas exposure include all of the following? - visual disturbances - flaccid muscles - nausea and vomiting - Not tachycardia 26. a symptom of an improbable survivor of radiation exposure would be? - Bloody diarrhea 27. To treat cutaneous anthrax, the nurse must? - Cleanse skin w/soap and water 28. Botulism typically requires which action for pt treatment? - Mechanical ventilation 29. When there is a chemical spill on workers, what should the nurse do first? - continually flush the skin with water 30. Which medication should I administer for heroin overdose? - naloxone 31. Which patient is triaged as an emergency in the ER? - stridor and O2 level of 75% 32. A nurse is working the triage position in the Er. Which patient should the nurse see first? - a pt who has multiple injuries from a MVA 33. Which component of critical incident stress management involves learning to id stress reactions and how to manage them? - defusing 34. Which of the following conditions would be deemed \"green\" in a disaster triage scenario? - a broken thumb from falling debris 35. A nurse is reviewing tx protocols for bioterrorism agents. which one would be require a vaccine after exposure - Smallpox 36. an ER nurse is assessing a pt who reports taking an excessive amount of ASA. which is a clinical manifestation? - Tinnitus 37. What is a priority intervention for an external hemorrhage? - Stop the bleeding 38. A pt arrives w/ hyperthermia and temp of 105. Which is priority intervention? - Place a cooling blanket on the patient 39. Which intervention for frostbite of the lower extremities is correct? - soak feet in warm water for 30-40 minutes at a time 40. Which of the following is a clinical manifestation of internal bleeding? - increased pulse rate 41. Patients experiencing frostbite need to avoid - ETOH and caffeine 42. Your pt has ingested poison, what is the priority intervention? - remove or inactivate poison ASAP 43. clinical manifestations of carbon monoxide poisoning - skin color ranges from pink to red - appears confused, headache, decreased LOC - muscular weakness, palpitation, dizziness 44. your pt has been bitten by a snake, which of the following is priority? - remove restrictive items 45. The nurse\'s role is to do the greatest good for the person you can save - False 46. reversal agent for Sedatives \[diazepam, lorazepam, midazolam\] - Flumanzenil 47. wear gloves when rinsing off lye and white phosphorus - False 48. treatment for snake bites - Antivenom most effective within 4 hours of bite - Measure arm to monitor swelling and take a pic to document - DO NOT USE: ice, tourniquets, heparin, or steroids in the first 6-8 hours. 49. General Nursing Management of Hemorrhage - When these patients come in, ensure they have 2 large-bore IVs (18 gauge is preferred but 20 gauge okay)-Needed bc you will be giving blood. Type & cross-match the blood. IV fluids -- NS or Lactated Ringers. Pt can also receive platelets to help clot 50. clinical manifestations of hemorrhage - clammy, decreased blood pressure - rigid abdomen 51. as a heat stroke progresses you will see? - confusion, delirium - elevated body temp with hot dry skin - no sweating, decreased BP, increase RR, HR