RPN Emergency Response 5 — Questions and Answers
Question 1: A patient with a suspected pulmonary embolism has sudden onset of pleuritic chest pain, dyspnea, and tachycardia. The MOST definitive diagnostic test the nurse should prepare the patient for is:
- Chest X-ray
- 12-lead ECG
- CT pulmonary angiography (CTPA) (Correct answer)
- D-dimer blood test
Correct answer: CT pulmonary angiography (CTPA)
CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism, directly visualizing clots in the pulmonary vasculature.
Question 2: A patient is in the ED after an industrial chemical splash to both eyes. The nurse's IMMEDIATE intervention is:
- Apply antibiotic eye drops and patch both eyes
- Irrigate both eyes copiously with normal saline for at least 20–30 minutes (Correct answer)
- Administer IV corticosteroids to reduce inflammation
- Obtain a slit-lamp ophthalmologic exam before treatment
Correct answer: Irrigate both eyes copiously with normal saline for at least 20–30 minutes
Continuous copious eye irrigation is the priority intervention for chemical eye exposure to dilute and remove the offending agent before it causes permanent damage.
Question 3: A nurse is caring for a patient with a traumatic amputation of the right hand. After controlling bleeding, the nurse correctly manages the amputated part by:
- Placing the part directly on ice to freeze it
- Wrapping it in moist saline gauze, placing in a sealed bag, and keeping it on ice without direct contact (Correct answer)
- Submerging the part in a bag of normal saline on ice
- Leaving the part at room temperature until surgical arrival
Correct answer: Wrapping it in moist saline gauze, placing in a sealed bag, and keeping it on ice without direct contact
The amputated part should be wrapped in moist saline gauze, placed in a sealed plastic bag, and kept cool on ice (not frozen) to preserve viability for reimplantation.
Question 4: A patient with a known peanut allergy receives a medication and develops wheezing and urticaria. The nurse administers epinephrine. After 5 minutes, symptoms persist. The nurse should:
- Wait 15 more minutes before considering a second dose
- Administer a second dose of epinephrine (Correct answer)
- Switch to oral diphenhydramine
- Administer IV hydrocortisone as the next treatment
Correct answer: Administer a second dose of epinephrine
If anaphylaxis symptoms persist after the first dose of epinephrine, a second dose may be administered 5–15 minutes after the first.
Question 5: A nurse assesses a patient with a suspected stroke. Which assessment finding would make the nurse suspect a hemorrhagic stroke over an ischemic stroke?
- Sudden onset of unilateral facial droop
- Report of the 'worst headache of my life' with rapid onset (Correct answer)
- Gradual onset of unilateral arm weakness over 30 minutes
- History of atrial fibrillation
Correct answer: Report of the 'worst headache of my life' with rapid onset
A sudden, severe 'thunderclap' headache described as the worst of one's life is a hallmark symptom of subarachnoid hemorrhage, a type of hemorrhagic stroke.
Question 6: A patient presents with a core temperature of 28°C (82.4°F), absent shivering, bradycardia, and hypotension. The nurse recognizes this as:
- Mild hypothermia
- Moderate hypothermia
- Severe hypothermia (Correct answer)
- Normal temperature variant in cold environments
Correct answer: Severe hypothermia
Severe hypothermia (below 30°C) is characterized by cessation of shivering, cardiovascular instability, and risk of cardiac arrest.
Question 7: During a disaster drill, the incident commander asks the charge nurse to activate the hospital emergency operations plan. The nurse's first action is to:
- Call all off-duty staff to return immediately
- Notify the charge nurse of each unit to prepare for surge capacity
- Follow the chain of command as outlined in the hospital's emergency operations plan (Correct answer)
- Move all current patients to discharge as quickly as possible
Correct answer: Follow the chain of command as outlined in the hospital's emergency operations plan
The hospital's emergency operations plan establishes a clear chain of command through the Hospital Incident Command System (HICS) that must be followed during any disaster.
RPN Emergency Response 5
A patient with a suspected pulmonary embolism has sudden onset of pleuritic chest pain, dyspnea, and tachycardia.
The MOST definitive diagnostic test the nurse should prepare the patient for is: