Cancer Questions 1. A client is being admitted to the hospital after receiving a radiation implant for cervical cancer.

The nurse takes which priority action in the care of this client? a) encourages the family to visit b) admits the client to a private room c) places the client on reverse isolation d) encourages the client to take frequent rest periods 2. A client is to undergo weekly intravesical chemotherapy for bladder cancer for the next 8 weeks. The nurse interprets that the client understands how to manage the urine as a biohazard if the client states to: a) void into a bedpan and then empty the urine into the toilet b) disinfect the urine and toilet with bleach for 6 hours following a treatment c) purchase extra bottles of scented disinfectant for daily bathroom cleansing d) have one bathroom strictly set aside for the client's use for the 8 weeks 3. The nurse is developing a plan of care for a client being admitted to the hospital who is immunosuppressed and will be placed on neutropenic precautions. With regard to neutropenic precautions, which intervention is incorrect? a) admitting the client to a semiprivate room b) placing a precaution sign on the door to the room c) placing a mask on the client if the client leaves the room d) removing a vase with fresh flowers left by a previous client 4. The nurse is preparing to change the linens and gown of a client who was incontinent of urine. The client had received an unsealed radiation source earlier in the day for treatment of thyroid cancer. The nurse wears which of the following protective items? a) mask and gloves b) gown and gloves c) mask, gown, and gloves d) gown, gloves, and eyewear 5. The nurse receives a telephone call from the hospital admission office and is informed that a client is being admitted who will undergo implantation of a sealed internal radiation source. The nurse asks the admission office clerk if which of the following rooms is selected for the client? a) a single room near the nurse's station b) a single room at the distant end of the hall c) a semiprivate room near the nurse's station d) a semiprivate room between two isolation rooms 6. The nurse has provided home-care instructions to a client recovering from a radial vulvectomy. Which statement by the client indicates the need for further instructions? a) I need to take showers rather than tub baths b) I need to monitor for foul-smelling perineal discharge ) I need to wipe from front to back after a bowel movement d) I need to notify the physician if swelling of the groin or genital area persists for longer than 1 week 7. The community health nurse provides an educational session regarding the risk factors for cervical cancer to women in the local community. The nurse determines that further teaching is needed if a woman attending the session identifies which of the following as a risk factor for this type of cancer? a) smoking tobacco b) low socioeconomic class c) early age of first intercourse d) white race 8. The nurse has completed discharge teaching with a client who has had surgery for lung cancer. The nurse determines that the client has misunderstood essential elements of home management if the client verbalizes the need to: a) avoid exposure to crowds b) deal with any increases in pain independently c) sit up and lean forward to breathe more easily d) call the physician in case of increased temperature or shortness of breath

9. The nurse is taking a history from a client who is suspected of having testicular cancer. Which of the following data will be most helpful for determining the client's risk factors for this type of cancer? a) age and race b) marital status c) number of children d) number of sexual partners 10. The community health nurse provides an educational session to members of the local community regarding the breast self-examination (BSE). Which statement by a member indicates the need for further education? a) I need to perform a BSE every month b) I should perform a BSE when I have my period c) It is easiest to perform a BSE when I am in the shower when my hands are soapy d) I'll use the finger pads of my three middle fingers to feel for lumps and thickening

Answers and Rationale 1) B - The client who has a radiation implant is placed in a private room and has limited visitors. This reduces the exposure of others to the radiation. Reverse isolation is unnecessary. Frequent rest periods are a helpful general intervention but are not a priority for the client in this situation. 2) B - After intravesical chemotherapy, the client treats the urine as a biohazard. This involves disinfecting the urine and the toilet with household bleach for 6 hours following a treatment. There is no value in using a bedpan for voiding. Scented disinfectants are of no particular use. The client does not need to have a separate bathroom for personal use. 3) A - The client who is on neutropenic precautions is immunosuppressed and is admitted to a single (private) room on the nursing unit. A precaution sign should be placed on the door to the client's room. The client should wear a mask whenever leaving the room to be protected from exposure to microorganisms. Standing water and fresh flowers should be removed to decrease the microorganism count. 4) B - In caring for the incontinent client who has received an unsealed radiation source, the nurse should wear gloves and a gown to protect the hands and uniform from contamination with urine. Generally, traces of the radioactive isotope are found in urine, feces, emesis, and wound drainage. 5) B - The client receiving an implantation of a sealed internal radiation source should be placed in a single room in an area that reduces the risk of exposure to others. For this reason, rooms are often used that are at the end of a hall. 6) D - The physician needs to be notified if any swelling of the groin or genital area occurs, and the client should not wait 1 week before notifying the physician. Options A, B, and C are accurate instructions. Additionally, the client should monitor for pain, redness, or tenderness in the calves and for any signs of infection. 7) D - Risk factors for cervical cancer include being black or Native American, smoking tobacco, having a low socioeconomic status, an early age of first intercourse, having multiple sexual partners or a partner who had multiple sexual partners, untreated chronic cervicitis, sexually transmitted diseases, and having a partner with a history of penile or prostate cancer.

8) B - Health teaching for this condition includes using positions that facilitate respiration, such as sitting up and leaning forward. It also includes avoiding exposure to crowds or persons with respiratory infections and reporting signs and symptoms of respiratory infection or increases in pain. The client should not be expected to deal with increases in pain independently. 9) A - Two basic but important risk factors for testicular cancer are age and race. The incidence of testicular cancer is four times higher among white males than black males. It is the most common type of cancer to occur in males between the ages of 15 and 34 years. Other risk factors include a history of an undescended testis and a family history of testicular cancer. Marital status and the number of children are not risk factors for testicular cancer. 10) B - The best time to perform a BSE is after (not during) the monthly period, when the breasts are not tender and swollen. Options A, C, and D identify accurate information regarding the BSE.

Emergency Nursing Questions: 1. The nurse is triaging four clients injured in a train derailment. Which client should receive priority treatment? A. A 42-year-old with dyspnea and chest asymmetry B. A 17-year-old with a fractured arm C. A 4-year-old with facial lacerations D. A 30-year-old with blunt abdominal trauma 2.Direct pressure to a deep laceration on the clients lower leg has failed to stop the bleeding. The nurses next action should be to: A. Place a tourniquet proximal to the laceration. B. Elevate the leg above the level of the heart. C. Cover the laceration and apply an ice compress. D. Apply pressure to the femoral artery. 3.A pediatric client is admitted after ingesting a bottle of vitamins with iron. Emergency care would include treatment with: A. Acetylcysteine B. Deferoxamine C. Calcium disodium acetate D. British antilewisite 4.The nurse is preparing to administer Ringers Lactate to a client with hypovolemic shock. Which intervention is important in helping to stabilize the clients condition? A. Warming the intravenous fluids B. Determining whether the client can take oral fluids C. Checking for the strength of pedal pulses D. Obtaining the specific gravity of the urine 5.The emergency room staff is practicing for its annual disaster drill. According to disaster triage, which of the following four clients would be cared for last? A. A client with a pneumothorax B. A client with 70% TBSA full thickness burns C. A client with fractures of the tibia and fibula D. A client with smoke inhalation injuries 6.An unresponsive client is admitted to the emergency room with a history of diabetes mellitus. The clients skin is cold and clammy, and the blood pressure reading is 82/56. The first step in emergency treatment of the

clients symptoms would be: A. Checking the clients blood sugar B. Administering intravenous dextrose C. Intubation and ventilator support D. Administering regular insulin 7.A client with a history of severe depression has been brought to the emergency room with an overdose of barbiturates. The nurse should pay careful attention to the clients: A. Urinary output B. Respirations C. Temperature D. Verbal responsiveness 8.A client is to receive antivenin following a snake bite. Before administering the antivenin, the nurse should give priority to: A. Administering a local anesthetic B. Checking for an allergic response C. Administering an anxiolytic D. Withholding fluids for 68 hours 9.The nurse is caring for a client following a radiation accident. The client is determined to have incorporation. The nurse knows that the client will: A. Not need any medical treatment for radiation exposure B. Have damage to the bones, kidneys, liver, and thyroid C. Experience only erythema and desquamation D. Not be radioactive because the radiation passes through the body 10.The emergency staff has undergone intensive training in the care of clients with suspected anthrax. The staff understands that the suggested drug for treating anthrax is: A. Ancef (cefazolin sodium) B. Cipro (ciprofloxacin) C. Kantrex (kanamycin) D. Garamycin (gentamicin)

Answer Rationales 1. Answer A is correct. Following the ABCDs of basic emergency care, the client with dyspnea and asymmetrical chest should be cared for first because these symptoms are associated with flail chest. Answer D is incorrect because he should be cared for second because of the likelihood of organ damage and bleeding. Answer B is incorrect because he should be cared for after the client with abdominal trauma. Answer C is incorrect because he should receive care last because his injuries are less severe. Answer B is correct. If bleeding does not subside with direct pressure, the nurse should elevate the extremity above the level of the heart. Answers A and D are done only if other measures are ineffective, so they are incorrect. Answer C would slow the bleeding but will not stop it, so its incorrect. Answer B is correct. Deferoxamine is the antidote for iron poisoning. Answer A is the antidote for acetaminophen overdose, making it wrong. Answers C and D are antidotes for lead poisoning, so they are wrong. Answer A is correct. Warming the intravenous fluid helps to prevent further stress on the vascular system. Thirst is a sign of hypovolemia; however, oral fluids alone will not meet the fluid needs of the client in hypovolemic shock, so answer B is incorrect. Answers C and D are wrong because they can be used for baseline information but will not help stabilize the client. Answer B is correct. The client with 70% TBSA burns would be classified as an emergent client. In disaster triage, emergent clients, code black, are cared for last because they require the greatest expenditure of resources. Answers A and D are examples of immediate clients and are assigned as code red, so they are wrong. These clients are cared for first because they can survive with limited interventions. Answer C is wrong because it is an example of a delayed client, code yellow. These clients have significant injuries that require medical care. Answer A is correct. The client has symptoms of insulin shock and the first step is to check the clients blood sugar. If indicated, the client should be treated with intravenous dextrose. Answer B is wrong because it is not the first step the nurse should take. Answer C is

wrong because it does not apply to the clients symptoms. Answer D is wrong because it would be used for diabetic ketoacidosis, not insulin shock. 7. Answer B is correct. Barbiturate overdose results in central nervous system depression, which leads to respiratory failure. Answers A and C are important to the clients overall condition but are not specific to the question, so they are incorrect. The use of barbiturates results in slow, slurred speech, so answer D is expected, and therefore incorrect. Answer B is correct. The nurse should perform the skin or eye test before administering antivenin. Answers A and D are unnecessary and therefore incorrect. Answer C would help calm the client but is not a priority before giving the antivenin, making it incorrect. Answer B is correct. The client with incorporation radiation injuries requires immediate medical treatment. Most of the damage occurs to the bones, kidneys, liver, and thyroid. Answers A, C, and D refer to external irradiation, so they are wrong. Answer B is correct. Cipro (ciprofloxacin) is the drug of choice for treating anthrax. Answers A, C, and D are not used to treat anthrax, so they are incorrect.

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Emergency Nursing Outline A. General information 1. Emergency nursing deals with human responses to any trauma or sudden illness that requires immediate intervention to prevent imminent severe damage or death 2. Care is provided in any setting to persons of all ages with actual or perceived alterations in physical or emotional health. 3. Initially, patients may not have a medical diagnosis. 4. Care is episodic when patients return frequently, primary when it is the initial option for health or preventive care, or acute when patients need immediate and additional interventions. 5. Emergency nursing is a specialty area of the nursing profession like no other. 6. Emergency nurses must be ready to treat a wide variety of illnesses or injury situations, ranging from a sore throat to a heart attack. B. Historical Development of Emergency Nursing 1. Florence Nightingale was the first emergency nurse, providing care to the wounded in the Crimean War in 1854 2. The Emergency Department Nurses Association (EDNA) was organized in 1970 3. A competency-based examination, first administered in 1980, provides Certification in Emergency Nursing; certification is valid for 4 years 4. EDNA developed Standards of Emergency Nursing Practice, published in 1983, to be used as a guideline for excellence and outcome criteria against which performance is measured and evaluated 5. In 1985, the Association name was changed to Emergency Nurses Association (ENA), recognizing the practice of emergency nursing as role-specific rather than sitespecific. 6. Originally ENA aimed at teaching and networking, the organization has evolved into an authority, advocate, lobbyist, and voice for emergency nursing. It has 30,000+ members and continues to grow, with members representing over 32 countries around the world. C. Emergency Care Environment 1. Prehospital care by emergency medical services (EMS), emergency medical technicians, and paramedics provides initial stabilizations and transport of patients; personnel communicate with the emergency department during patient transport 2. The national emergency telephone number 911 is the result of an effort to improve access to EMS 3. The concept of the emergency room has expanded to that of the emergency department, which provides various levels of care 4. Specialized electronic technology and techniques are used to monitor patient status continuously; these may pose safety hazards to patients, such as possible exposure to electric shock D. Triage 1. Triage classifies emergency patients for assessment and treatment priorities 2. Triage decisions require gathering objective and subjective data rapidly and effectively to determine the type of priority situation present 3. Emergent situations are potentially life-threatening; they include such conditions as respiratory distress or arrest, cardiac arrest, severe chest pain, seizures, hemorrhage, severe trauma resulting in open chest or abdominal wounds, shock, poisonings, drug overdoses, temperatures over 105F (40.5C), emergency childbirth, or delivery complications

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Urgent situations are serious but not life-threatening if treatment is delayed briefly; they include such conditions as chest pain without respiratory distress, major fractures, burns, decreased level of consciousness, back injuries, nausea or vomiting, severe abdominal pain, temperature between 102 and 105F (38.9 and 40.5 C), bleeding from any orifice, acute panic, or anxiety 5. Nonemergency situations are not acute and are considered minor to moderately severe; they include such conditions as chronic backache or other symptoms, moderate headache, minor burns, fractures, sprains, upper respiratory or urinary infections, or instances in which a patient is dead on arrival E. Roles of the Emergency Nurse 1. Care provider: provides comprehensive direct care to the patient and family. 2. Educator: provides patient and family with education based on their learning needs and the severity of the situation and allows the patient to assume more responsibility for meeting health care needs 3. Manager: coordinates activities of others in the multidisciplinary team to achieve the specific goal of providing emergency care 4. Advocate: ensures protection of the patients rights F. Functions of the Emergency Nurse 1. Uses triage to determine priorities based on assessment and anticipation of the patients needs 2. Provides direct measures to resuscitate, if necessary 3. Provides preliminary care before the patient is transferred to the primary care area 4. Provides health education to the patient and family 5. Supervises patient care and ancillary personnel 6. Provides support and protection for the patient and family G. Legal issues affecting the provision of emergency nursing 1. Negligence 2. Malpractice 3. Good Samaritan Laws (these statutes may protect private citizens but usually do not apply to emergency personnel on duty or in normal emergency situations) 4. Informed consent 5. Implied consent 6. Duty to report suspected crimes to the police 7. Duty to gather evidence in criminal investigations; be aware of hospital policy and state laws for evidence collection 8. Advanced directives, including durable power of attorney and living wills H. Qualifications of an Emergency Nurse 1. An emergency nurse is a registered nurse with specialized education and experience in caring for emergency patients. 2. Emergency nurses continually update their education to stay informed of the latest trends, issues, and procedures in medicine today. 3. Many take a special examination that proves their level of knowledge. After successful completion of this exam they are certified in emergency nursing. 4. Some emergency nurses also acquire additional certifications in the areas of trauma nursing, pediatric nursing, nurse practitioner, and various areas of injury prevention 5. Many emergency nurses acquire additional certifications in the areas of trauma nursing, pediatric nursing, nurse practitioner, and various areas of injury prevention