Emergency Nursing
Midterm Exam
Course Introduction
Emergency Nursing is a dynamic course designed to equip students with the knowledge and skills necessary for providing rapid, effective care to patients experiencing acute illnesses or traumatic injuries. Emphasizing critical thinking, prioritization, and communication, the course covers the assessment, stabilization, and management of patients in emergency situations across the lifespan. Key topics include triage, airway management, trauma care, cardiac and respiratory emergencies, shock, wound care, and disaster preparedness. Students will also explore legal, ethical, and cultural considerations unique to emergency nursing practice. Through case studies, simulations, and hands-on experiences, learners will develop competencies essential for functioning in high-pressure, fast-paced healthcare environments.
Recommended Textbook
Priorities in Critical Care Nursing 7th Edition by Urden
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27 Chapters
761 Verified Questions
761 Flashcards
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Page 2
Chapter 1: Caring for the Critically Ill Patient
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14 Verified Questions
14 Flashcards
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Sample Questions
Q1) A specific therapy or care that is an option to what is considered conventional treatment of a condition is known as
A) Guided Imagery.
B) holistic care.
C) complementary care.
D) individualized care.
Answer: C
Q2) A patient was admitted to a rural ICU in Montana.Critical care nurses are assisting with monitoring and care of the patient from the closest major city.This is an example of A) telemedicine.
B) tele-ICU.
C) tele-informatics.
D) tele-hospital.
Answer: B
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3
Chapter 2: Ethical and Legal Issues
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Sample Questions
Q1) Ethical decisions are best made by
A) following the guidelines of a framework or model.
B) having the client discuss alternatives with the physician or nurse.
C) prioritizing the greatest good for the greatest number of persons.
D) careful consideration by the Ethics Committee after all diagnostic data are reviewed.
Answer: A
Q2) A client's wife has been informed by the physician that her spouse has a permanent C2-C3 spinal injury, which has resulted in permanent quadriplegia.The wife states that she does not want the physician or nursing staff to tell the client about his injury.The client is awake, alert, and oriented when he asks his nurse to tell him what has happened.Based on which ethical principles does the nurse answer the patient's questions?
A) Veracity
B) Justice
C) Autonomy
D) Nonmaleficence
Answer: C
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Chapter 3: Patient and Family Education
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Sample Questions
Q1) Acute illness disrupts the patient's and family's normal routines.Coping mechanisms include
A) denial.
B) adaptation.
C) values.
D) anger.
E) disbelief.
Answer: A, D, E
Q2) Which of the following educational content areas is appropriate during the first hours of hospitalization?
A) Pathophysiology of the admitting diagnosis
B) Dietary modifications
C) Purpose of bedside equipment
D) Medication side effects
Answer: C
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Page 5
Chapter 4: Psychosocial and Spiritual Alterations and Management
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Sample Questions
Q1) A patient is admitted to the CCU complaining of pain from a femur fracture and is anxious and agitated.The patient is receiving steroids and theophylline for exacerbation of asthma.The nurse should assess the patient for A) anxiety.
B) low self-esteem.
C) regression.
D) suicidal ideations.
Q2) Psychologic and spiritual interventions have the power to engage a patient's A) hope.
B) fear.
C) will to survive.
D) energy.
E) ability to meet life's challenges.
Q3) _____ occurs when the critical illness is so severe that the patient or family becomes overwhelmed.
A) Anxiety
B) Spiritual distress
C) Stress overload
D) Hopelessness
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Chapter 5: Sleep Alterations
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Sample Questions
Q1) A patient was given the diagnosis of congestive heart failure (CHF)2 years ago.The patient complains of increased daytime sleepiness and states his support system has been complaining more and more about snoring.Central sleep apnea is suspected.Treatment depends on whether the patient has hypercapnic or nonhypercapnic central sleep apnea.The patient's primary treatment plan should include
A) CPAP.
B) bilevel positive airway pressure (BiPAP).
C) acetazolamide and medroxyprogesterone.
D) modafinil and zolpidem.
Q2) Interventions to help with circadian synchronization include A) opening the window blinds.
B) encouraging the patient to take frequent naps during the day.
C) administering sedatives at bedtime.
D) keeping the patient awake during the early morning hours.
Q3) The primary determinant in the efficacy of CPAP in patients with OSA is A) compliance.
B) weight.
C) tonsil size.
D) respiratory effort.
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Chapter 6: Nutritional Alterations
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30 Flashcards
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Sample Questions
Q1) Which of the following signs would alert the nurse to possible nutritional alterations?
A) Impaired wound healing
B) Edema
C) Nail growth
D) Muscle atrophy
E) diaphoresis
Q2) A patient is admitted to the critical care unit with severe malnutrition as a result of hepatic failure.A triple-lumen central venous catheter is placed in the right subclavian vein, and TPN is started.For which of the following complications should the patient be evaluated immediately after insertion of the catheter?
A) Pneumothorax
B) Hypoglycemia
C) Central venous thrombosis
D) Pulmonary aspiration
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8
Chapter 7: Gerontological Alterations
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Sample Questions
Q1) A 68-year-old patient has been admitted to the coronary care unit after an inferior myocardial infarction.Dopamine 3 mcg/kg/min has been ordered for this patient.What nursing implications should be considered when administering this drug to an older patient?
A) No changes are noted in older patients with this drug.
B) Drug effect is enhanced by increased receptor site action.
C) Increased breakdown by liver hepatocytes occurs, increasing dosage requirements.
D) Drug metabolism and detoxification are slowed, increasing the risks of drug toxicity.
Q2) An older patient is starting a new medication that is metabolized in the liver and excreted by the kidneys.Which is the best assessment to monitor the patient's ability to tolerate the medication?
A) Liver function tests
B) Drug side effects experienced by the patient
C) Kidney function tests
D) Therapeutic drug levels
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Chapter 8: Pain and Pain Management
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Sample Questions
Q1) The neural processes of encoding and processing noxious stimuli necessary but not sufficient for pain is known as
A) perception.
B) nociception.
C) transduction.
D) transmission.
Q2) The subjective characteristic implies that pain is
A) an uncomfortable experience present only in the patient with an intact nervous system.
B) an unpleasant experience accompanied by crying and tachycardia.
C) activation of the sympathetic nervous system from an injury.
D) whatever the patient experiencing it says it is, occurring when that patient says it does.
Q3) Using a specific pain intensity scale in the CCU
A) eliminates the need for the subjectivity of the patient.
B) allows for one tool for all patient types.
C) provides consistency of assessment and documentation.
D) is not necessary because all pain is treated equally in the CCU.
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Chapter 9: Sedation, Agitation and Delirium Management
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Sample Questions
Q1) A 56-year-old patient is admitted to the critical care unit with acute respiratory distress syndrome (ARDS).The patient has been intubated and is mechanically ventilated.The patient is becoming increasingly agitated, and the high-pressure alarm on the ventilator has been frequently triggered.After the patient's agitation is controlled, which of the following drugs would be most appropriate for long-term sedation?
A) Morphine 2 mg/hr continuous IV drip
B) Haloperidol 15 mcg/kg/min continuous IV infusion
C) Propofol 5 mcg/kg/min by IV infusion
D) Lorazepam 0.01 to 0.1 mg/kg/hr by IV infusion
Q2) Causes of delirium in critically ill patients include
A) hyperglycemia.
B) meningitis.
C) cardiomegaly.
D) pulmonary embolism.
E) alcohol withdrawal syndrome.
F) hyperthyroidism.
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Chapter 10: End of Life Care
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Sample Questions
Q1) _____ is a powerful influence when the decision-making process is dealing with recovery or a peaceful death.
A) Hope
B) Religion
C) Culture
D) Ethics
Q2) Which of the following are considerations when making the decision to allow family at the bedside during resuscitation efforts?
A) The patient's wishes
B) Experience of the staff
C) The family's need to participate in all aspects of the patient's care
D) State regulatory issues
E) Seeing the resuscitation may confirm the impact of decisions made or delayed
Q3) Antiemetics should be used to treat
A) dyspnea.
B) nausea and vomiting.
C) anxiety.
D) edema.
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Chapter 11: Cardiovascular Clinical Assessment and Diagnostic Procedures
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88 Flashcards
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Sample Questions
Q1) The presence of a carotid or femoral bruit may be evidence of
A) left-sided heart failure.
B) blood flow through a partially occluded vessel.
C) the early onset of pulmonary embolism.
D) myocardial rupture.
Q2) _____ are created by the turbulence of blood flow through a vessel caused by constriction of the blood pressure cuff.
A) Korotk off sounds
B) Pulse pressures
C) Murmurs
D) Gallops
Q3) The nurse assesses the dorsalis pedis and posterior tibial pulses as weak and thready.Indicate the correct documentation for the pulse volume that the nurse would use.
A) 0
B) 1+
C) 2+
D) 3+
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Chapter 12: Cardiovascular Disorders
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30 Flashcards
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Sample Questions
Q1) Which of the following cholesterol values indicates a heightened risk for the development of CAD?
A) Total cholesterol level of 170 mg/dL
B) HDL cholesterol level of 30 mg/dL
C) Triglyceride level of 120 mg/dL
D) LDL cholesterol level >190 mg/dL
Q2) Data concerning coronary artery disease (CAD)and specific risk factors have demonstrated
A) a low correlation of modifiable risk factors to CAD.
B) the onset of CAD in middle age.
C) an association between development of specific risk factors and CAD.
D) no decisive correlation between risk factors and CAD.
Q3) An essential aspect of teaching that may prevent recurrence of heart failure is
A) notifying the physician if a 2-lb weight gain occurs in 24 hours.
B) compliance with diuretic therapy.
C) taking nitroglycerin if chest pain occurs.
D) assessment of an apical pulse.
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14
Chapter 13: Cardiovascular Therapeutic Management
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Sample Questions
Q1) A transvenous pacemaker is inserted through the right subclavian vein and threaded into the right ventricle.The pacemaker is placed on demand at a rate of 70.The pacing mode for this pacemaker is
A) VVI.
B) AOO.
C) DDD.
D) VAT.
Q2) Vasopressors are used cautiously with critical care patients because they can cause A) vasoconstriction of the smooth muscles.
B) vasodilation of the smooth muscles.
C) increased afterload of the heart.
D) decreased preload of the heart.
Q3) The most common complication of fibrinolytic therapy is A) reperfusion chest pain.
B) lethargy.
C) bleeding.
D) heart blocks.
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Chapter 14: Pulmonary Clinical Assessment and Diagnostic
Procedures
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46 Flashcards
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Sample Questions
Q1) The creation of sound waves across the body surface to determine abnormal densities is known as
A) inspection.
B) palpation.
C) percussion.
D) auscultation.
Q2) A patient is admitted to the critical care unit with acute respiratory failure.Upon auscultation, the health care provider hears creaking, leathery, coarse breath sounds in the lower anterolateral chest area during inspiration and expiration.The nurse suspects that the patient has a(n)
A) emphysema.
B) atelectasis.
C) pulmonary fibrosis.
D) pleural friction rub.
Q3) V/Q scans are ordered to evaluate the possibility of which of the following?
A) Pulmonary emboli
B) Acute myocardial infarction
C) Emphysema
D) Acute respiratory distress syndrome
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Chapter 15: Pulmonary Disorders
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Sample Questions
Q1) A pneumothorax greater than 15% requires
A) systemic antibiotics to treat the inflammatory response.
B) an occlusive dressing to equalize lung pressures.
C) interventions to evacuate the air from the pleural space and facilitate re-expansion of the collapsed lung.
D) mechanical ventilation to assist with re-expansion of the collapsed lung.
Q2) Patients with left-sided pneumonia may benefit from placing them in which of the following positions?
A) Reverse Trendelenburg
B) Supine
C) On the left side
D) On the right side
Q3) Which of the following diagnostic criteria is indicative of ARDS?
A) Radiologic evidence of bibasilar atelectasis
B) PaO<sub>2</sub>/FiO<sub>2</sub> ratio less than or equal to 200 mm Hg
C) Pulmonary artery wedge pressure greater than 18 mm Hg
D) Increased static and dynamic compliance
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Chapter 16: Pulmonary Therapeutic Management
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Sample Questions
Q1) Nursing interventions to limit the complications of suctioning include
A) inserting the suction catheter no more than 5 inches.
B) premedicating the patient with atropine.
C) hyperoxygenating the patient with 100% oxygen.
D) increasing the suction to 150 mm Hg.
Q2) Which of the following should be used when suctioning a mechanically ventilated patient?
A) Three hyperoxygenation breaths (breaths at 100% FiO<sub>2</sub>)
B) Hyperinflation (breaths at 150% tidal volume)
C) Limit the number of passes to three.
D) Instill 5 to 10 mL of normal saline to facilitate secretion removal.
E) Use intermittent suction to avoid damaging tracheal tissue.
Q3) Which of the following oxygen administration devices can deliver oxygen concentrations of 90%?
A) Nonrebreathing mask
B) Nasal cannula
C) Partial rebreathing mask
D) Simple mask
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Chapter 17: Neurologic Clinical Assessment and Diagnostic
Procedures
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Sample Questions
Q1) A score of 6 on the Glasgow Coma Scale (GCS)indicates A) a vegetative state.
B) paraplegia.
C) coma.
D) obtundation.
Q2) The GCS is an invalid measure for the patient with A) hemiplegia.
B) Parkinson disease.
C) mental retardation.
D) intoxication.
Q3) Testing of extraocular eye movements assesses
A) pupillary response to light.
B) function of the three cranial nerves of the eye.
C) the ability of the eyes to accommodate to a closer moving object.
D) the oculocephalic reflex.
Q4) The initial history for the neurologically impaired patient needs to be A) limited to the chief complaint.
B) comprehensive, including events preceding hospitalization.
C) directed to level of consciousness and pupillary reaction.
D) information that only the patient can provide.
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Chapter 18: Neurologic Disorders and Therapeutic Management
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Sample Questions
Q1) Which nursing interventions will help prevent sharp spikes in ICP and surgical hemorrhage?
A) Keep the head of the bed elevated 45 to 90 degrees.
B) Administer an antiemetic to prevent vomiting.
C) Provide fluid restriction.
D) Help with turn, cough, and deep breathe exercises.
Q2) Downward displacement of the hemispheres, basal ganglia, and diencephalon through the tentorial notch is indicative of
A) central herniation.
B) uncal herniation.
C) cingulate herniation.
D) infratentorial herniation.
Q3) The stroke patient who has difficulty with speech has A) expressive aphasia.
B) global aphasia
C) receptive aphasia.
D) apraxia.
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Page 20
Chapter 19: Kidney Clinical Assessment and Diagnostic
Procedures
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Sample Questions
Q1) A patient has been on complete bed rest for 3 days.The health care provider has ordered for the patient to sit at the bedside for meals.The patient complains of feeling dizzy and faint while sitting at the bedside.The nurse anticipates that the patient is experiencing
A) orthostatic hypertension.
B) orthostatic hypotension.
C) hypervolemia.
D) electrolyte imbalance.
Q2) Which of the following auscultatory parameters may exist in the presence of hypovolemia?
A) Hypertension
B) Third or fourth heart sound
C) Orthostatic hypotension
D) Vascular bruit
Q3) Percussion of kidneys is usually done to
A) assess the size and shape of the kidneys.
B) detect pain in the renal area.
C) elicit a fluid wave.
D) evaluate fluid status.
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Chapter 20: Kidney Disorders and Therapeutic Management
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Sample Questions
Q1) Which electrolytes pose the most potential hazard if not within normal limits for a person with renal failure?
A) Phosphorous and calcium
B) Potassium and calcium
C) Magnesium and sodium
D) Phosphorous and magnesium
Q2) An elderly patient is in a motor vehicle accident and sustains a significant internal hemorrhage.Which category of renal failure is the patient at the greatest risk of developing?
A) Intrinsic
B) Postrenal
C) Prerenal
D) Acute tubular necrosis
Q3) To control azotemia, the recommended nutritional intake of protein is
A) .5 to 1.0 g/kg/day.
B) 1.2 to 1.5 g/kg/day.
C) 1.7 to 2.5 g/kg/day.
D) 2.5 to 3.5 g/kg/day.
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Chapter 21: Gastrointestinal Clinical Assessment and Diagnostic Procedures
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Sample Questions
Q1) Steatorrhea is determined by which laboratory study?
A) Gastric acid stimulation
B) Urea breath test
C) Culture and sensitivity
D) Stool studies
Q2) When assessing the abdomen, how long must the nurse listen to the abdomen to be able to accurately chart that bowel sounds are absent?
A) 30 seconds in each quadrant
B) 1 minute
C) 3 minutes
D) 5 minutes
Q3) The patient has just returned from a liver biopsy.The patient should be positioned on the
A) left side for 2 hours.
B) right side for 2 hours.
C) left side for 6 to 8 hours.
D) right side for 6 to 8 hours.
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Page 23
Chapter 22: Gastrointestinal Disorders and Therapeutic Management
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Sample Questions
Q1) Which classification of medication is used to reduce volume and concentration of gastric secretions?
A) Antacids
B) Histamine<sub>2</sub> (H<sub>2</sub>) antagonists
C) Gastric mucosal agents
D) Gastric proton pump inhibitors
Q2) A nursing priority for a patient with GI hemorrhage is
A) positioning the patient in a high-Fowler position.
B) airway protection.
C) irrigating the nasogastric tube with iced saline.
D) maintaining venous access so that fluids and blood can be administered.
Q3) The patient at risk for GI hemorrhage should be monitored for which of the following signs and symptoms?
A) Metabolic acidosis and hypovolemia
B) Decreasing hemoglobin and hematocrit
C) Hyperkalemia and hypernatremia
D) Hematemesis and melena
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Page 24
Chapter 23: Endocrine Clinical Assessment and Diagnostic Procedures
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Sample Questions
Q1) A normal HbA<sub>1</sub>c level for a normal person is A) less than 5.4%.
B) less than 6.5%.
C) between 5.4% and 6.5%.
D) between 3% and 5.4%.
Q2) The patient weighed 62 kg on admission yesterday.Today the patient weighs 60 kg.The nurse knows this reflects a fluid loss of
A) 1 L.
B) 2 L.
C) 4 L.
D) 10 L.
Q3) The nurse knows that an abnormal response to the ADH test would be A) a slight increase in urine osmolality.
B) a decrease in urine output.
C) a decrease in serum osmolality.
D) no change in urine osmolality.
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25
Chapter 24: Endocrine Disorders and Therapeutic Management
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Sample Questions
Q1) A patient with diabetes in the critical care unit is at risk for developing diabetic ketoacidosis (DKA)secondary to
A) excess insulin administration.
B) inadequate food intake.
C) physiologic and psychologic stress.
D) increased release of antidiuretic hormone (ADH).
Q2) A patient was admitted with diabetic ketoacidosis 1 hour ago and is on an insulin drip.Suddenly, the nurse notices frequent premature ventricular contractions (PVCs)on the electrocardiogram.The expected intervention would be to
A) administer a lidocaine bolus.
B) administer a lidocaine drip.
C) synchronize cardioversion.
D) evaluate electrolytes.
Q3) Characteristics of diabetes insipidus (DI)are
A) hyperglycemia and hyperosmolarity.
B) hyperglycemia and peripheral edema.
C) intense thirst and passage of excessively large quantities of dilute urine.
D) peripheral edema and pulmonary crackles.
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Chapter 25: Trauma
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Sample Questions
Q1) Motor vehicle crashes (MVCs)and falls are the greatest cause of A) spinal shock.
B) blunt thoracic trauma.
C) maxillofacial injuries
D) penetrating thoracic injuries.
Q2) Major trauma patients are at a high risk of developing deep venous thrombosis and pulmonary embolism because of A) blood stasis.
B) hypernatremia.
C) injury to the intimal surface of the vessel.
D) hyperosmolarity.
E) hypercoagulopathy.
F) immobility.
Q3) Fat embolism syndrome can occur as a complication of A) liver trauma.
B) burns.
C) orthopedic trauma.
D) spleen trauma.
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27
Chapter 26: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome
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Sample Questions
Q1) One theory suggests that organ dysfunction in MODS occurs in a sequential or progressive pattern.Place the following organs in the order in which they are affected:
1)Bone marrow
2)Cardiac
3)Gut
4)Kidneys
5)Liver
6)Lungs
A) 6, 5, 2, 1, 3, 4
B) 5, 4, 6, 1, 2, 3
C) 6, 5, 3, 4, 2, 1
D) 6, 3, 4, 5, 2, 1
Q2) The nursing measure that can best enhance large volumes of fluid replacement in hypovolemic shock is
A) insertion of a large-diameter peripheral intravenous catheter.
B) positioning the patient in the Trendelenburg position.
C) forcing at least 240 mL of fluid each hour.
D) administering intravenous lines under pressure.
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Chapter 27: Hematologic Disorders and Oncologic Emergencies
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Sample Questions
Q1) A patient was admitted to the critical care unit with gram-negative sepsis 5 days ago.Today there is continual oozing from his intravenous sites, and ecchymosis of the skin is noted beneath his automatic blood pressure cuff.On his laboratory work, his platelets are normal, and his international normalized ratio is elevated.What other laboratory value would be most valuable in definitively diagnosing the patient's condition?
A) Fibrin split products
B) D-Dimer level
C) Bleeding time
D) White blood cell count
Q2) A patient is admitted into the critical care unit with symptoms of a low-grade fever, joint pain, tachycardia, hepatomegaly, photophobia, and an inability to follow commands.The patient is becoming more agitated and complaining of pain.The nurse suspects that the patient has
A) ITP.
B) heparin-induced thrombocytopenia.
C) sickle cell anemia.
D) DIC.
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