A nurse witnesses a motor vehicle accident (MVA) while off duty. Upon approaching the scene, the nurse observes a victim lying on the ground after being ejected from the vehicle
Arrange the actions the nurse should take in the correct order, starting with the first. All options must be used.
Choice 1. Check the victim's breathing.
Choice 2. Check the victim's pulse.
Choice 3. Check the victim's airway.
Choice 4. Immobilize the spine.
Choice 5. Check for the victim's responsiveness.
Correct Answer: 5, 3, 1, 2, 4
In an emergency situation, the nurse first assesses the patient's level of consciousness during the primary survey of CPR. All people who have sustained trauma to the head or spine, or who are unconscious, should be treated as though they have a spinal cord injury. Prehospital management includes rapid assessment of the ABCs (airway, breathing, circulation) and then immobilizing and stabilizing the head and neck.
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The pediatric nurse explains to a new mother that two factors, "nature" and "nurture," may influence the formation of her child's essence. A factor that would be considered "nature" is:
A) parenting skills. B) genetic makeup. C) cultural aspects. D) the era in which the child develops.
Which clinical manifestation should the nurse expect to see as shock progresses in a child and becomes decompensated shock? (Select all that apply.)
a. Thirst and diminished urinary output b. Irritability and apprehension c. Cool extremities and decreased skin turgor d. Confusion and somnolence e. Normal blood pressure and narrowing pulse pressure f. Tachypnea and poor capillary refill time
Which symptom is consistent with an inhalation burn?
a. Full-thickness burns to chest b. Hypotension c. Agitation d. Persistent coughing
A client is instructed by a nurse to correctly perform incentive spirometry by:
A. Assuming a sitting position B. Inhaling rapidly C. Holding the breath for 15 seconds D. Exhaling quickly