RPN Emergency Response 2 — Questions and Answers
Question 1: A patient arrives in the ED with a suspected tension pneumothorax. Which finding is MOST indicative of this condition?
- Bilateral crackles on auscultation
- Tracheal deviation away from the affected side (Correct answer)
- Tracheal deviation toward the affected side
- Dullness to percussion over the affected side
Correct answer: Tracheal deviation away from the affected side
Tension pneumothorax causes increased intrapleural pressure that shifts the trachea and mediastinum away from the affected side.
Question 2: During a mass casualty incident, a patient is found unresponsive with no spontaneous respirations even after repositioning the airway. Under START triage, this patient is tagged:
- Red (immediate)
- Yellow (delayed)
- Green (minor)
- Black (expectant/deceased) (Correct answer)
Correct answer: Black (expectant/deceased)
START triage tags non-breathing patients who remain apneic after airway repositioning as black (expectant/deceased) due to resource limitations.
Question 3: A patient with a severe bee sting allergy develops hypotension, urticaria, and stridor. The nurse's FIRST action is to administer:
- Diphenhydramine IV
- Methylprednisolone IV
- Epinephrine 1:1,000 IM into the lateral thigh (Correct answer)
- Albuterol via nebulizer
Correct answer: Epinephrine 1:1,000 IM into the lateral thigh
Epinephrine 1:1,000 administered IM into the vastus lateralis is the first-line treatment for anaphylaxis to reverse bronchospasm and vasodilation.
Question 4: A patient is admitted after ingesting an unknown substance. The nurse notes pinpoint pupils, bradycardia, and excessive secretions. Which antidote should the nurse prepare?
- Naloxone
- Flumazenil
- Atropine (Correct answer)
- N-acetylcysteine
Correct answer: Atropine
These are classic signs of organophosphate or cholinergic toxicity, and atropine is the primary antidote to block muscarinic effects.
Question 5: A child is brought to the ED after a near-drowning event. The child is conscious and coughing. The nurse's priority intervention is:
- Administer 100% oxygen and monitor for respiratory deterioration (Correct answer)
- Discharge with home observation instructions
- Obtain a chest X-ray before any intervention
- Place an NG tube to remove swallowed water
Correct answer: Administer 100% oxygen and monitor for respiratory deterioration
All near-drowning victims require supplemental oxygen and observation for delayed pulmonary edema and hypoxia even if initially appearing well.
Question 6: A patient with chest trauma has paradoxical chest wall movement during respiration. The nurse recognizes this as:
- Open pneumothorax
- Hemothorax
- Flail chest (Correct answer)
- Cardiac tamponade
Correct answer: Flail chest
Flail chest occurs when three or more consecutive ribs are fractured in two places, causing the segment to move opposite to the rest of the chest wall.
Question 7: A patient receiving a blood transfusion develops sudden fever, chills, and back pain 30 minutes into the infusion. The nurse's FIRST action is:
- Slow the infusion rate and administer diphenhydramine
- Stop the transfusion, maintain IV access with normal saline, and notify the provider (Correct answer)
- Administer acetaminophen and continue monitoring
- Obtain a stat chest X-ray
Correct answer: Stop the transfusion, maintain IV access with normal saline, and notify the provider
These symptoms suggest an acute hemolytic transfusion reaction; the transfusion must be stopped immediately to prevent life-threatening hemolysis.
RPN Emergency Response 2
A patient arrives in the ED with a suspected tension pneumothorax.
Which finding is MOST indicative of this condition?